Assessment of results of thoraco – laparoscopic esophagectomy in patients receiving neoadjuvant chemoradiotherapy for esophageal cancers

Abstract

Introduction: Laparoscopic esophagectomy plays an important role in esophageal cancer. In recent years, the treatment of esophageal cancer is multidisciplinary, especially in neoadjuvant chemoradiotherapy for stages from IIB-IV to downstage to increase the possibility of R0 resection and survival. Globally, there have many studies showing the feasibility, safety, and effectiveness of laparoscopic esophagectomy after neoadjuvant chemoradiotherapy in patients with esophageal cancers. In Vietnam, there has been a paucity of data and surgical results in this group of patients. Therefore, we conducted a study to evaluate the safety, feasibility, and effectiveness of laparoscopic esophagectomy in patients receiving neoadjuvant chemoradiotherapy for esophageal cancers at Viet Duc Hospital.

Patients and methods: A retrospective study of patients who underwent the thoraco-laparoscopic esophagectomy receiving neoadjuvant chemoradiotherapy at Viet Duc hospital from T9/ 20217- T9/2021.

Results:  From September 2017 to September 2021, there were 30 patients with esophageal cancer receiving neoadjuvant chemoradiotherapy followed by thoraco-laparoscopic esophagectomy. 100% were male, the mean age was 55.2 years old. Tumor locations in the middle and lower third parts were 53.3% and 46.7% respectively.  96.7% was squamous cell carcinoma, adenocarcinoma accounted for 3.3%. Before chemoradiotherapy stage III, and IV was 80%; 16.7%, after chemoradiotherapy, stages II and III were 43.3% and 40%. The average operation duration was 283 minutes, the average blood loss during video assisted thoracotomy was 60ml, there were no intraoperative complications, and there were no cases requiring conversion to open thoracotomy. The duration of intubation was 2.1 days, the average hospital stay was 12.5 days. There were 13.3% respiratory complications and 6.7% had experienced anastomosis leak. There were no postoperative deaths. The average number of harvested lymph nodes was 19, the lymph node metastasis rate was 43%. R0 resection rate was 93,4%. The results were 40% consistent completely with the histopathological examination. The mean survival time after surgery was 27 ± 3.7 (months), and the survival rate after 2 years was 42%.

Conclusions: Thoraco-laparoscopic esophagectomy after neoadjuvant chemoradiotherapy is a feasible, safe, and beneficial procedure for post-surgery recovery of patients.

Keywords: Esophagael cancer, Thoraco-laparoscopic esophagectomy, neoadjuvant chemoradiotherapy.

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