P136 Comparison of Totally Minimally and Hybrid Ivor Lewis Esophagectomy for Cancer of Distal Esophagus and Esophagogastric Junction

Abstract

Aim Aim of this retrospective study is the comparison of the short-terms outcomes and QoL of Hybrid Ivor Lewis (HIL) and Totally Minimally Invasive Ivor Lewis (TMIIL). Background & Methods Minimally invasive techniques for esophagectomy represents a challenging procedure with aiming to decrease cardiopulmonary complications and guarantee better quality of life (QoL) compared to open techniques, without compromising oncological radicality. Patients with cancer of distal esophagus and EGJ were included into (HIL) and (TMIIL) groups in the period January 2017 – March 2019. General features, intraoperative and postoperative results were analyzed. For all the patients a feeding jejunostomy was performed. The surgical radicality and number of resected nodes were also evaluated. QoL was determined preoperatively, at 7 and 90 days postoperatively with EORTC QLQ-C30 questionnaire. Results Eighteen and 24 patients were submitted to TMIIL and HIL respectively. General features were similar in the two groups. Median intervention duration was 360 minutes [range: 240-420] in TMIIL group and 335 minutes [range: 150-400] for HIL group (p=0.0647). Median blood losses were similar for TMIIL and HIL group, 100 ml [range:50-400] and 175 ml [50-350] respectively (p=0.0831). No differences were observed in terms of postoperative complications CD≥2. One exitus occurred in HIL group (CD=5), none in TMIIL group (p=n.s). No differences were evidenced for median number of lymphnodes harvested in the two group as well for rate of R0 and R1 resections. Results obtained from the QoL questionnaires evidenced a reduction of postoperative pain during the first 7 postoperative day for patients in the TMIIL group compared to HIL; these data were confirmed by the analysis conducted on postoperative day 90, as well for the global health status, physical functioning and role functioning. Conclusion Our experience evidenced TMIIL esophagectomy seems to give the similar results, of HIL influencing positively the QoL within 90-day after surgery. Duration of surgery and anastomotic leaks are the key elements influencing the learning curve. Randomized controlled trials are necessary to confirm the good results obtained and to give recommendations to avoid a high rate of complications