The Prognostic Impact of Minimally Invasive Esophagectomy on Survival after Esophagectomy following a Delayed Interval after Chemoradiotherapy; A Secondary Analysis of the DICE Study
Markar, Sheraz R; Sgromo, Bruno; Evans, Richard; Griffiths, Ewen A; Alfieri, Rita; Castoro, Carlo; Gronnier, Caroline; Gutschow, Christian A; Piessen, Guillaume; Capovilla, Giovanni; Grimminger, Peter P; Low, Donald E; Gossage, James; Gisbertz, Suzanne S; Ruurda, Jelle; van Hillegersberg, Richard; D'journo, Xavier Benoit; Phillips, Alexander W; Rosati, Ricardo; Hanna, George B; Maynard, Nick; Hofstetter, Wayne; Ferri, Lorenzo; Berge Henegouwen, Mark I; Owen, Richard
(2024) Annals of surgery, volume 280, issue 4, pp. 650 - 658
(Article)
Abstract
Objective: To evaluate prognostic differences between minimally invasive esophagectomy (MIE) and open esophagectomy (OE) in patients with surgery after a prolonged interval (>12 wk) following chemoradiotherapy (CRT). Background: Previously, we established that a prolonged interval after CRT before esophagectomy was associated with poorer long-term survival. Methods: This was an international
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multicenter cohort study involving 17 tertiary centers, including patients who received CRT followed by surgery between 2010 and 2020. Patients undergoing MIE were defined as thoracoscopic and laparoscopic approaches. Results: A total of 428 patients (145 MIE and 283 OE) had surgery between 12 weeks and 2 years after CRT. Significant differences were observed in American Society of Anesthesiologists grade, radiation dose, clinical T stage, and histologic subtype. There were no significant differences between the groups in age, sex, body mass index, pathologic T or N stage, resection margin status, tumor location, surgical technique, or 90-day mortality. Survival analysis showed MIE was associated with improved survival in univariate (P=0.014), multivariate analysis after adjustment for smoking, T and N stage, and histology (HR=1.69; 95% CI: 1.14-2.5) and propensity-matched analysis (P=0.02). Further subgroup analyses by radiation dose and interval after CRT showed survival advantage for MIE in 40 to 50 Gy dose groups (HR=1.9; 95% CI: 1.2-3.0) and in patients having surgery within 6 months of CRT (HR=1.6; 95% CI: 1.1-2.2). Conclusions: MIE was associated with improved overall survival compared with OE in patients with a prolonged interval from CRT to surgery. The mechanism for this observed improvement in survival remains unknown, with potential hypotheses including a reduction in complications and improved functional recovery after MIE.
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Keywords: esophagectomy, minimally invasive esophageal cancer, salvage esophagectomy, Surgery
ISSN: 0003-4932
Publisher: Lippincott Williams & Wilkins
Note: Publisher Copyright: © 2024 Wolters Kluwer Health. All rights reserved.
(Peer reviewed)