Abstract
BackgroundLocally advanced esophageal carcinoma is typically treated with neoadjuvant chemoradiation and esophagectomy (trimodality therapy). We compared the long-term oncologic outcomes of minimally invasive Ivor Lewis esophagectomy (M-ILE) cohort with a propensity score weighted cohort of open Ivor Lewis esophagectomy (O-ILE) cases after trimodality therapy.MethodsThis is a retrospective review of 223 patients diagnosed with esophageal carcinoma who underwent neoadjuvant chemoradiation followed by M-ILE or O-ILE from April 2009 to February 2019. Inverse probability of treatment weighting (IPTW) adjustment was used to balance the baseline characteristics between study groups. Kaplan–Meier survival curves were calculated for overall survival and recurrence-free survival comparing the two groups. Multivariate Cox proportional hazards regression models were used to determine predictive variables for overall and recurrence-free survival.ResultsThe IPTW cohort included patients with esophageal carcinoma who underwent M-ILE (n = 142) or O-ILE (n = 68). The overall rate of postoperative adverse events was not significantly different after IPTW adjustment between the O-ILE and M-ILE trimodality groups (53.4% vs. 39.2%, p = 0.089). The 3-year overall survival (OS) for the M-ILE group was 59.4% (95% CI: 49.8–67.8) compared to 55.7% (95% CI: 39.2–69.4) for the O-ILE group (p = 0.670). The 3-year recurrence-free survival for the M-ILE group was 59.9% (95% CI: 50.2–68.2) compared to 61.6% (95% CI: 41.9–76.3) for the O-ILE group (p = 0.357). A complete response to neoadjuvant chemoradiation was significantly predictive of improved OS and RFS.ConclusionThe overall and recurrence-free survival rates for M-ILE were not significantly different from O-ILE for esophageal carcinoma after trimodality therapy. Complete response to neoadjuvant chemoradiation was predictive of improved overall and recurrence- free survival.
Highlights
In the United States, there were an estimated 17,650 newly diagnosed cases of esophageal carcinoma in 2019 [1]
The randomized Chemoradiotherapy for Oesophageal Cancer followed by Surgery Study (CROSS) Trial demonstrated improved overall survival and disease-free survival for patients who underwent preoperative chemoradiation followed by esophagectomy for locally advanced esophageal carcinoma [2]
We reported a propensity score adjusted comparison of the long-term oncologic outcomes between minimally invasive Ivor Lewis esophagectomy (M-ILE) and open Ivor Lewis esophagectomy (O-ILE) performed for patients with locally advanced esophageal carcinoma who completed neoadjuvant chemoradiation
Summary
In the United States, there were an estimated 17,650 newly diagnosed cases of esophageal carcinoma in 2019 [1]. The randomized Chemoradiotherapy for Oesophageal Cancer followed by Surgery Study (CROSS) Trial demonstrated improved overall survival and disease-free survival for patients who underwent preoperative chemoradiation followed by esophagectomy for locally advanced esophageal carcinoma [2]. A single center cohort study demonstrated fewer postoperative complications and a shorter hospital length of stay for minimally invasive esophagectomy compared to the open approach [9]. We reported a propensity score adjusted comparison of the long-term oncologic outcomes (overall survival and recurrence-free survival) between M-ILE and O-ILE performed for patients with locally advanced esophageal carcinoma who completed neoadjuvant chemoradiation. We compared the long-term oncologic outcomes of minimally invasive Ivor Lewis esophagectomy (M-ILE) cohort with a propensity score weighted cohort of open Ivor Lewis esophagectomy (O-ILE) cases after trimodality therapy
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