PS01.147: BODY MASS INDEX AND PERIOPERATIVE OUTCOMES AFTER ESOPHAGECTOMY: THORACOABDOMINAL APPROACH HAS EQUIVALENT RESULTS AS MINIMALLY INVASIVE ESOPHAGECTOMY

Abstract

Abstract Background A thoracoabdominal approach to esophagectomy provides excellent exposure to the lower esophagus and gastroesophageal junction, particularly in obese patients and in patients with prior chest or abdominal surgery. However, thoracoabdominal esophagectomy (TE) has been associated with higher rates of perioperative complications and limits to the extent of resection, which may have oncologic consequences. Selectively approaching most obese or re-operative patients with esophageal cancer following neoadjuvant therapy through an open thoracoabdominal incision, the aim of this study was to compare perioperative complications and short-term oncologic outcomes of TE with minimally invasive Ivor-Lewis esophagectomy (MIE). Methods All esophageal cancer patients who underwent neoadjuvant treatment followed by MIE or TE with curative intent at a tertiary referral center between 2008 and 2017 were identified using a prospectively maintained database. Primary outcomes were oncological adequacy, including extent of lymph node resection and R0 resection rates, and perioperative complications including pneumonia, anastomotic leakage and chylothorax. Secondary outcomes included length of stay and readmission rates. Results A total of 171 patients were included, of whom 139 patients underwent MIE and 32 patients TE. Patients who underwent TE had a significantly higher body mass index (BMI) (mean 30.6 vs 26.5, P = 0.001) and were more likely to have relevant surgical history (56% vs 1%, P = 0.001). R0 resection rates were the same regardless of operative approach. Pathologic N-stage was the same between groups, though total lymph node yield was higher with MIE (mean 15 vs 20, P = 0.006). The rate of postoperative complications was not increased with TE. Median length of stay was one day longer in the TE group (P = 0.007). Conclusion In patients with esophageal cancer, resection is often more challenging in the setting of obesity or prior surgery, particularly in patients treated with neoadjuvant therapy. By selectively employing a thoracoabdominal approach in these difficult cases equivalent oncologic outcomes can be achieved, with no significant increase in postoperative complications, as compared with MIE. This study demonstrates that patient-specific selection in surgical approach can lead to comparable postoperative results. Further studies are warranted to evaluate effects on long-term outcomes. Disclosure All authors have declared no conflicts of interest.