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：

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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.	中國醫師協會食管外科專家委員會. 微創食管癌切除術(minimally invasive esophagectomy, MIE)專家共識. 中華胸心血管外科雜志, 2013, 29(7): 385-387.
8.	楊弘, 傅劍華, 劉孟忠, 等. 術前放化療并手術治療局部晚期食管鱗癌的多中心隨機對照臨床研究. 中華醫學雜志, 2012, 92(15): 1028-1032.
9.	郭旭峰, 方文濤. 新分期指導下進展期食管癌術前誘導化療再思考. 中華外科雜志, 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.	鄭浩, 汪灝, 唐漢, 等. 新輔助同步放化療與新輔助化療治療局部進展期食管鱗癌的療效分析. 中華消化外科雜志, 2017, 16(5): 464-468.
15.	郭旭峰, 孫濤 ,葉波, 等. 術中非計劃事件對于微創食管癌根治術患者術后早期康復的影響. 中華胸部外科電子雜志, 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. 中國醫師協會食管外科專家委員會. 微創食管癌切除術(minimally invasive esophagectomy, MIE)專家共識. 中華胸心血管外科雜志, 2013, 29(7): 385-387.
8. 楊弘, 傅劍華, 劉孟忠, 等. 術前放化療并手術治療局部晚期食管鱗癌的多中心隨機對照臨床研究. 中華醫學雜志, 2012, 92(15): 1028-1032.
9. 郭旭峰, 方文濤. 新分期指導下進展期食管癌術前誘導化療再思考. 中華外科雜志, 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. 鄭浩, 汪灝, 唐漢, 等. 新輔助同步放化療與新輔助化療治療局部進展期食管鱗癌的療效分析. 中華消化外科雜志, 2017, 16(5): 464-468.
15. 郭旭峰, 孫濤 ,葉波, 等. 術中非計劃事件對于微創食管癌根治術患者術后早期康復的影響. 中華胸部外科電子雜志, 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

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