Feasibility of minimally invasive esophagectomy after neoadjuvant chemoradiation

The impact of preoperative chemoradiation treatment (CRT) on outcomes after esophagectomy is still debated. The choice of surgical approach can also be influenced by this treatment modality, including the performance of minimally invasive esophagectomy (MIE), a technically demanding procedure. We sought to examine the outcomes of MIE after CRT.

We conducted a retrospective analysis of consecutive MIEs performed at two institutions from June 2004 to January 2010. We analyzed the effect of CRT on perioperative results, including pulmonary complications, oncological outcomes, length of stay, and mortality.

In total, 126 patients were eligible for the study. Six patients (4.8%) were converted from MIE to an open approach and were excluded from the analysis. Of the 120 patients, 98 were male (82%), mean age was 62 ± 13 years (range, 22-88 years), and 58 underwent CRT (48%) (Group 1). Comparing both groups, the incidence of pneumonia (9 versus 11), recurrent laryngeal nerve injury (3 versus 5), anastomotic leaks (4 versus 9), number of harvested lymph nodes (16 ± 9 versus 18 ± 9), and R0 resection margins (53/58 versus 61/62) was comparable (Group 1 versus Group 2, respectively; P=not significant). There was a trend toward more pleural effusions in Group 1 (10 versus 4, P=.09). Median length of stay was comparable between both groups (10 ± 11 versus 11 ± 7 days). There were three operative deaths, exclusively in Group 1 (P=.11).

MIE can be safely performed after CRT in the management of esophageal cancer, with a low conversion rate. Outcomes seem comparable regardless of preoperative CRT.