Influence of Neoadjuvant Chemotherapy on Short-term Outcomes After Minimally Invasive Esophagectomy for Esophageal Cancer

Abstract

Background/Aim: The safety of minimally invasive esophagectomy (MIE) after neoadjuvant chemotherapy (NAC) for esophageal cancer has not been adequately confirmed. Patients and Methods: Two hundred and twelve patients who underwent MIE for esophageal cancer at the Kumamoto University Hospital between May 2011 and June 2018 were enrolled. A total of 46 patients received NAC and underwent subsequent MIE. The control group comprised 166 patients who underwent MIE without any preoperative treatments. We retrospectively investigated the patient-related, tumor-related, and surgery-related factors, as well as the short-term outcomes, between the two groups. Results: Preoperative lymphocyte counts and hemoglobin and albumin levels were significantly lower in the NAC plus MIE group than in the MIE alone group. Preoperative nutritional status, as measured by the prognostic nutrition index and controlling nutritional status, was also poorer in the NAC plus MIE group (p<0.001). However, short-term outcomes such as operation time, intraoperative blood loss, and incidence of postoperative complications were statistically equivalent between the groups. Conclusion: Although administration of NAC was associated with a poorer preoperative condition, it did not worsen the short-term outcomes after MIE. Esophagectomy, the main treatment for esophageal cancer, is highly invasive, and the incidences of postoperative morbidity and mortality of esophagectomy are higher than 471

Feasibility research of enhanced recovery after surgery implemented in esophageal cancer patients who underwent neoadjuvant chemotherapy

“…NACT followed by esophagectomy for treatment of ESCC has been widely accepted. Although chemotherapy may have some side effects such as leukopenia, previous studies have shown that NACT followed by esophagectomy is a feasible and safe, and there was no increase in postoperative complications and hospital length of stay after surgery [ 7 , 8 ]. However, NACT may lead to necrosis and fibrosis, which can increase the surgical duration and intraoperative blood loss [ 6 ].…”

“…The number of lymph nodes harvested was also similar for the two group. Meanwhile, Nomoto et al [ 7 ] showed that NACT followed by esophagectomy did not increase the operation time and intraoperative blood loss.…”

Influence of Induction Therapy on Robot-Assisted McKeown Esophagectomy for Esophageal Squamous Cell Carcinoma

“…In conventional video-assisted MIEs, some authors discussed and described the difference between induction therapy and front surgery. Nomoto et al [25] analyzed the influence of neoadjuvant chemotherapy on short-term outcomes after MIE for esophageal cancer. They found that short-term outcomes such as operation time, intraoperative blood loss, and incidence of postoperative complications were statistically equivalent between the groups.…”

Feasibility research of enhanced recovery after surgery implemented in esophageal cancer patients who underwent neoadjuvant chemotherapy

“…The number of lymph nodes harvested was also similar for the two group. Meanwhile, Nomoto, D. et al 7 showed that NACT followed by esophagectomy did not increase the operation time and intraoperative blood loss.…”

“…Although chemotherapy may have some side effects such as leukopenia, previous studies have shown that NACT followed by esophagectomy is a feasible and safe, and there was no increase in postoperative complications and hospital length of stay after surgery. 7,8 However, NACT may lead to necrosis and brosis, which can increase the surgical duration and intraoperative blood loss. 6 This was a little different from our study.…”