Safety of thoracoscopic esophagectomy after induction chemotherapy for locally advanced unresectable esophageal squamous cell carcinoma

Abstract

Introduction Recent studies have reported that induction chemotherapy with docetaxel plus cisplatin and 5‐fluorouracil (DCF) is an effective treatment for unresectable, locally advanced esophageal cancer. The aim of this study was to investigate the safety and feasibility of thoracoscopic esophagectomy (TE) after DCF for initially unresectable esophageal squamous cell carcinoma (ESCC). Methods Twenty‐three patients with initially unresectable T4 thoracic ESCC underwent TE after induction DCF. Results The neighboring organs with tumors were the tracheobronchus in nine patients, thoracic aorta in 13, and pericardium and diaphragm in three each (concurrent overlapping invasion occurred in five patients). The mean total operation time was 556.3 ± 107.2 minutes, and the mean time of the thoracic procedure was 258.9 ± 83.9 minutes. The mean total blood loss was 166.2 ± 117.8 mL, and the loss during the thoracic procedure was 33.5 ± 24.6 mL. All patients achieved complete R0 resection under TE. No conversions to open thoracotomy were performed. The postoperative morbidity rate was 34.8%. The postoperative hospital stay was 24.3 (range, 13‐38) days. Five patients had recurrence: four had distant metastasis (lung, two; liver, three; and one with overlap), and one had mediastinal lymph node recurrence. No local recurrence was noted at the site of the primary T4 tumor. Conclusions TE was safely performed in 23 patients after DCF therapy for locally advanced unresectable ESCC. Induction DCF, followed by TE, could be an alternative treatment for unresectable T4 ESCC.

The Long-Term Clinical Impact of Thoracic Endovascular Aortic Repair (TEVAR) for Advanced Esophageal Cancer Invading Aorta

“…4 This observation is consistent with the finding by other authors that radical surgical resection after chemoradiation can provide a chance of improved survival for selected patients with esophageal cancer invading an adjacent organ. [16][17][18] Trend test for correlation between disease-free survival and subgroups showed p = 0.003 in univariate analysis and p = 0.0.004 in multivariable analysis TEVAR was first introduced in the 1990s for endovascular repair of aortic aneurysms in patients who were thought to be inappropriate for open repair. 19 After success in the treatment of aortic aneurysm, the indications for TEVAR have expanded to include more complicated cases.…”

“… 4 This observation is consistent with the finding by other authors that radical surgical resection after chemoradiation can provide a chance of improved survival for selected patients with esophageal cancer invading an adjacent organ. 16 – 18 …”

Efficacy of thoracotomy and thoracoscopic-assisted esophageal surgery in conversion and salvage surgeries: a retrospective study

“…The Clavien–Dindo classification was used to assess perioperative complications [ 22 ]. Simply put, grade II indicated the need for pharmacological treatment.…”

“…In recent years, thoracoscopic esophagectomy without thoracotomy and, more recently, robot-assisted esophagectomy have been gradually generalized, and there are reports of CS and SS using the thoracoscopic approach in particular [ 22 ].…”

Comparison of Clinical Outcomes between Salvage and Elective Thoracic Endovascular Aortic Repair in Patients with Advanced Esophageal Cancer with Aortic Invasion: A Retrospective Cohort Study

“…Traditionally, advanced EC with aortic invasion is classified as T4b disease according to the 8th American Joint Committee on Cancer (AJCC) staging system [ 3 ] and is considered inoperable. However, there is growing evidence showing that radical surgical resection after chemoradiotherapy (CRT) can improve survival in selected patients [ 4 , 5 , 6 , 7 ]. Esophagectomy with combined open resection of the aorta has been performed in some Japanese high-volume centers, but the 30-day mortality was high [ 8 , 9 ].…”