Feasibility of neoadjuvant therapy followed by minimally invasive esophagectomy for locally advanced esophageal cancer: A case control study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Xufeng , YE Bo , YANG Yu , SUN Yifeng , HUA Rong , MAO Teng , ZHANG Xiaobing ,  LI Zhigang

Department of Thoracic Surgery, Section of Esophageal Cancer, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200030, P.R.China;

Corresponding author：

LI Zhigang, Email: dr_lizhigang@163.com

Keywords：

Neoadjuvant concurrent chemoradiotherapy; neoadjuvant chemotherapy; minimally invasive esophagectomy

DOI：

10.7507/1007-4848.201708035

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the safety and efficacy of neoadjuvant therapy followed by minimally invasive esophagectomy (MIE) for locally advanced esophageal cancer. Methods We retrospectively analyzed clinical data of 56 consecutive patients with locally advanced esophageal cancer treated by neoadjuvant therapy followed by surgery in our hospital between January 2015 and December 2016. There were 51 males and 5 females. The patients were divided into 2 groups. Neoadjuvant therapy followed by open surgery esophagectomy group was as an OE group with 25 patients aged 61 (50-73) years. And neoadjuvant therapy followed by MIE was as a MIE group with 31 patients aged 60 (55-79) years. Results The pathologic complete response (pCR) rate of 28 patients with neoadjuvant concurrent chemoradiotherapy was significantly higher than that of 28 patients with neoadjuvant chemotherapy (21.4% vs. 10.7%, P<0.05). The operation time, intraoperative blood loss, R2 rate and the number of lymph nodes dissection in the MIE group were obviously better than those of the OE group with statistical differences (P<0.05). However, there was no significant difference in the number of resected lymph nodes along the bilateral recurrent laryngeal nerves and lymph node metastasis rate (P>0.05) between the two groups. The incidence of postoperative respiratory complications in the MIE group was lower than that of the OE group (P=0.041). There was no significant difference between the two groups in the incidence of other complications, re-operation, re-entry to ICU, median length of stay or perioperative deaths (P>0.05). There was only one patient with neoadjuvant concurrent chemoradiotherapy in the OE group died due to gastric fluid asphyxia caused by trachea-esophageal fistula. Conclusion Neoadjuvant therapy followed by MIE for locally advanced esophageal cancer is safe and feasible. The oncological outcomes seem comparable regardless of OE.

Citation： GUO Xufeng, YE Bo, YANG Yu, SUN Yifeng, HUA Rong, MAO Teng, ZHANG Xiaobing, LI Zhigang. Feasibility of neoadjuvant therapy followed by minimally invasive esophagectomy for locally advanced esophageal cancer: A case control study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(3): 203-207. doi: 10.7507/1007-4848.201708035 Copy

1.	Wu PC, Posner MC. The role of surgery in the management of oesophageal cancer. Lancet Oncol, 2003, 4(8):481-488.
2.	van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med, 2012, 366(22): 2074-2084.
3.	Shapiro J, van Lanschot JJ, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal orjunctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
4.	Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol, 2012, 19(1): 68-74.
5.	Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive open oesophagectomy for patients with oesophageal cancer: a multicentre,open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
6.	Amin MB, Edge S, Greene FL, et al. AJCC Cancer Staging Manual. 8th ed. New York: Springer, 2017. 185-202.
7.	中国医师协会食管外科专家委员会. 微创食管癌切除术(minimally invasive esophagectomy, MIE)专家共识. 中华胸心血管外科杂志, 2013, 29(7): 385-387.
8.	杨弘, 傅剑华, 刘孟忠, 等. 术前放化疗并手术治疗局部晚期食管鳞癌的多中心随机对照临床研究. 中华医学杂志, 2012, 92(15): 1028-1032.
9.	郭旭峰, 方文涛. 新分期指导下进展期食管癌术前诱导化疗再思考. 中华外科杂志, 2013, 51(1): 1-3.
10.	Straatman J, van der Wielen N, Cuesta MA, et al. Minimally invasive versus open esophageal resection: three-year follow-up of the previously reported randomized controlled trial: the TIME trial. Ann Surg, 2017, 266(2): 232-236.
11.	Ben-David K, Rossidis G, Zlotecki RA, et al. Minimally invasive esophagectomy is safe and effective following neoadjuvant chemoradiationtherapy. Ann Surg Oncol, 2011, 18(12): 3324-3329.
12.	Bakhos C, Oyasiji T, Elmadhun N, et al. Feasibility of minimally invasive esophagectomy after neoadjuvant chemoradiation. J Laparoendosc Adv Surg Tech A, 2014, 24(10): 688-692.
13.	Spector R, Zheng Y, Yeap BY, et al. The 3-hole minimally invasive esophagectomy: a safe procedure following neoadjuvant chemotherapy and radiation. Semin Thorac Cardiovasc Surg, 2015, 27(2): 205-215.
14.	郑浩, 汪灏, 唐汉, 等. 新辅助同步放化疗与新辅助化疗治疗局部进展期食管鳞癌的疗效分析. 中华消化外科杂志, 2017, 16(5): 464-468.
15.	郭旭峰, 孙涛 ,叶波, 等. 术中非计划事件对于微创食管癌根治术患者术后早期康复的影响. 中华胸部外科电子杂志, 2016, 3(4): 199-203.

1. Wu PC, Posner MC. The role of surgery in the management of oesophageal cancer. Lancet Oncol, 2003, 4(8):481-488.
2. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med, 2012, 366(22): 2074-2084.
3. Shapiro J, van Lanschot JJ, Hulshof MC, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal orjunctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol, 2015, 16(9): 1090-1098.
4. Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol, 2012, 19(1): 68-74.
5. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive open oesophagectomy for patients with oesophageal cancer: a multicentre,open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
6. Amin MB, Edge S, Greene FL, et al. AJCC Cancer Staging Manual. 8th ed. New York: Springer, 2017. 185-202.
7. 中国医师协会食管外科专家委员会. 微创食管癌切除术(minimally invasive esophagectomy, MIE)专家共识. 中华胸心血管外科杂志, 2013, 29(7): 385-387.
8. 杨弘, 傅剑华, 刘孟忠, 等. 术前放化疗并手术治疗局部晚期食管鳞癌的多中心随机对照临床研究. 中华医学杂志, 2012, 92(15): 1028-1032.
9. 郭旭峰, 方文涛. 新分期指导下进展期食管癌术前诱导化疗再思考. 中华外科杂志, 2013, 51(1): 1-3.
10. Straatman J, van der Wielen N, Cuesta MA, et al. Minimally invasive versus open esophageal resection: three-year follow-up of the previously reported randomized controlled trial: the TIME trial. Ann Surg, 2017, 266(2): 232-236.
11. Ben-David K, Rossidis G, Zlotecki RA, et al. Minimally invasive esophagectomy is safe and effective following neoadjuvant chemoradiationtherapy. Ann Surg Oncol, 2011, 18(12): 3324-3329.
12. Bakhos C, Oyasiji T, Elmadhun N, et al. Feasibility of minimally invasive esophagectomy after neoadjuvant chemoradiation. J Laparoendosc Adv Surg Tech A, 2014, 24(10): 688-692.
13. Spector R, Zheng Y, Yeap BY, et al. The 3-hole minimally invasive esophagectomy: a safe procedure following neoadjuvant chemotherapy and radiation. Semin Thorac Cardiovasc Surg, 2015, 27(2): 205-215.
14. 郑浩, 汪灏, 唐汉, 等. 新辅助同步放化疗与新辅助化疗治疗局部进展期食管鳞癌的疗效分析. 中华消化外科杂志, 2017, 16(5): 464-468.
15. 郭旭峰, 孙涛 ,叶波, 等. 术中非计划事件对于微创食管癌根治术患者术后早期康复的影响. 中华胸部外科电子杂志, 2016, 3(4): 199-203.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Feasibility of neoadjuvant therapy followed by minimally invasive esophagectomy for locally advanced esophageal cancer: A case control study

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content