Neoadjuvant chemotherapy (TPF regimen) followed with robotic surgery and its impact on outcome in management of esophageal cancers: Indian experience.

Abstract

407 Background: Neo-adjuvant chemotherapy coupled with robotic three stage esophagectomy have shown promising results in esophageal cancer. Methods: 136 patients diagnosed with squamous cell cancer esophagus were included to analyze the benefit of NACT with DCF (docetaxel 75mg/m2 day 1, cisplatin 75mg/m2 day 1, 5-FU 750mg/m2 per day 1-4) regimen 3 cycles followed by three stage robotic esophagectomy. Esophagus, assessed by EUS and PET-CT scan, pre-chemo and post-chemo, in biopsy proven Squamous cell Carcinoma Oesophagus. All the data pertaining to chemotherapy and surgery were prospectively maintained in a data base. Results: Median age 62.7 years, male to female 5.9:4.1. T2 4%, T3 90% & T4 6%. N0 10% & N+90%. Post NACT, Partial response of 50.8%, and a complete pathological response of 27.6% was observed with response rate of 66.3%. 20 pts. had mucositis, but none had grade 3 toxicity, neutropenia in 24 pts. and febrile neutropenia in 7 pt., vomiting and fatigue in 35 pts. Mean blood loss 256.5±85.8ml, duration of surgery 322.4±28.4min, ICU stay 1.5±0.8-day, hospital stay 10.5±2.1 day. Proximal and distal margin was negative for all whereas only 2 patients had a positive CRM. Mean Lymph node yield was 22.4±3.5 nodes. All patients had complete robotic surgery with no conversions and major intraoperative complication. Post-operatively Minor complication was noted in 5 patients temporary vocal cord palsy, 10 delayed gastric emptying, wound infection in 3 and minor lung infection 9. Major complication in form of leak (3), stenosis (5), chylous leak (4) was noted. 30-day mortality 4.5%. With the longest follow up of 50 months, 3 year DFS and OS was 75.4% & 68% respectively. Conclusions: Neoadjuvant chemotheraphy with TPF regimen showed excellent response rates with minimal G3 toxicity and is well tolerated in Indian patients. Combination of NACT with robotic esophagectomy has excellent outcome with low morbidity & mortality.