Clinical effect of neoadjuvant chemo radiation combined with thoracoscopic and laparoscopic three-incision esophagectomy

Objective:To explore the clinical effect of neoadjuvant chemoradiation combined with thoracoscopic and laparoscopic threeincision esophagectomy for esophageal cancer.
Methods:The retrospective cohort study was conducted. The clinicopathological data of 111 esophageal cancer patients who underwent neoadjuvant chemoradiation combined with thoracoscopic and laparoscopic threeincision esophagectomy in the Cancer Hospital of Chinese Academy of Medical Sciences between January 2010 and December 2016 were collected. Among 111 patients, 68 with interval time between neoadjuvant chemoradiation and thoracoscopic and laparoscopic threeincision esophagectomy <-8 weeks were allocated into the <-8 weeks group and 43 with interval time between neoadjuvant chemoradiation and thoracoscopic and laparoscopic threeincision esophagectomy ≥8 weeks were allocated into the ≥8 weeks group. Patients underwent preoperative radiotherapy and chemotherapy with TP regimen, and then underwent selective thoracoscopic and laparoscopic threeincision esophagectomy. Observation indicators: (1) neoadjuvant chemoradiation situations; (2) surgical and postoperative situations; (3) followup. Followup using outpatient examination and telephone interview was performed to detect postoperative survival of patients and tumor recurrence or metastasis up to March 2017. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Count data were analyzed using the chisquare test or Fisher exact probability. Comparison of ranked data was done by the nonparametric test.
Results:(1) Neoadjuvant chemoradiation situations: all the patients underwent neoadjuvant chemoradiation, without severe adverse reaction. Number of patients with complete remission based on oncopathology were 34 in the <8 weeks group and 15 in the ≥8 weeks group, with no statistically significant difference between the 2 groups (x²=2.441, P>0.05). (2) Surgical and postoperative situations: all the patients underwent successful thoracoscopic and laparoscopic threeincision esophagectomy, with negative surgical margins. Operation time, volume of intraoperative blood loss, number of lymph node dissected, time of postoperative intrathoracic drainagetube removal, time of postoperative neck drainagetube removal, hoarseness, upper gastrointestinal hemorrhage, anastomotic fistula, respiratory complication, pleural effusion and empyema, cardiovascular complication, incision abnormal healing, death within postoperative 30 days and duration of hospital stay were (354±103)minutes, (400±76)mL, 19±4, (11±4)days, (4.9±1.6)days, 5, 1, 12, 3, 6, 5, 8, 0, (19±17) days in the <-8 weeks group and (343±92) minutes, (392±51)mL, 19±3, (12±6)days, (4.5±1.0)days, 2, 0, 7, 5, 3, 4, 3, 2, (18±11)days in the ≥8 weeks group, respectively, with no statistically significant difference between the 2 groups (t=1.080, 0. 569, 0.326, 1.223, 1.286, x²=0.029, 0.035, 1.114, 0.000, 0.000, 0.246, t=0.315, P>0.05). (3) Followup: 90 of 111 patients were followed up for 3-82 months, with a median time of 25 months, including 55 in the <8 weeks group and 35 in the ≥8 weeks group. During followup, death and tumor recurrence were detected in 9, 11 patients in the <8 weeks group and 6, 11 patients in the ≥8 weeks group, respectively.
Conclusion:Neoadjuvant chemoradiation combined with thoracoscopic and laparoscopic threeincision esophagectomy is safe and effective, and it doesn′t increase the perioperative risks based on preoperative 8week interval time.