PS01.210: VIDEO-ASSISTED SALVAGE ESOPHAGECTOMY: SHORT- AND LONG-TERM OUTCOMES

Abstract

Abstract Background Salvage surgery is only one therapeutic option which enable to cure intractable esophageal cancer after definitive chemo-radiotherapy. Although video-assisted esophagectomy (VAE) is now widely accepted as a standard operation for primary esophageal cancer, the application of VAE to salvage surgery is still controversial since salvage surgery is known as high-risk operation. In this study, we investigated 27 cases of salvage surgery and assessed the feasibility of the operation by analyzing their short and long-term outcomes. Methods VAE was applied to 26 cases and laparoscopic lymphadenectomy was applied to 1 case. The procedure of the VAE included prone position esophagectomy (n = 8), esophagectomy by hand-assisted thoracoscopic surgery (n = 10) and mediastinoscope-assisted transhiatal esophagectomy (n = 5). Our current operative procedure after year 2010 is PPE. The fields of lymph node dissection for salvage esophagectomy have been limited to the stations that had metastasis before CRT and the lymphatic stations which newly recognized as suspected metastasis. Postoperative complications were defined according to the Clavien-Dindo classification. Results Video assisted surgery was applied to 96% of patients including one case of laparoscopic abdominal lymphadenectomy. One case required open surgery for suspicious of direct invasion of tumor. R0 rate of the operations was scored 78%. Postoperative complication rate defined as ≥ C-D II plus any grade of anastomotic leakage and recurrent laryngeal nerve palsy was 63%. The rate of anastomotic leakage, respiratory complication, and RLN palsy were 23%, 15%, and 12%, respectively. Operative death was 0%, whereas in-hospital mortality was 3.7%. Overall survival of esophagectomy cases showed 24% in 3-year and 8% in 5-year. According to subgroup analysis by pathological R status after operation, the survival outcomes of pR0 group (n = 20) reached 32% in 3-year and 10% in 5-year OS, whereas no patient reached 3-year survival in pR1/2 group (n = 6; P = 0.02). Conclusion Although salvage VAE should be applied in high-experienced institutions under the careful consideration of indication, it appears to be balanced operation for safety, and less invasiveness, as well as curability. Disclosure All authors have declared no conflicts of interest.