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Quality of oncological resection criteria in minimally invasive esophagectomy

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Abstract

Background

Even though minimally invasive esophageal surgery (MIE) is spreading, questions remain regarding its oncological outcomes. The aim of this study was to assess the quality of oncological resection criteria in MIE.

Methods

All patients undergoing a two-way Ivor Lewis esophagectomy for esophageal or junctional cancer between 2010 and 2020 in a single tertiary upper gastrointestinal surgery ward were analyzed retrospectively. The following oncological criteria were analyzed: lymph node (LN) harvest and location, positive lymph node rate, margins, and R0 rates. They were compared between the MIE group (thoracoscopy + laparoscopy) and the hybrid group (H/O, thoracotomy + laparoscopy).

Results

Among the 240 patients included, 34 (14%) had MIE and 206 a hybrid esophagectomy. Main surgical indication was lower thoracic adenocarcinoma and the rate of neoadjuvant treatments administered (chemotherapy or chemoradiotherapy) was comparable between both groups (p = 1.0). LN harvest was significantly higher in the MIE group (31 ± 9 vs. 28 ± 9, p = 0.04) as well as thoracic LN harvest (14 ± 7 vs. 11 ± 5, p = 0.002). When analyzing patients according to T stage and response to neoadjuvant treatments, patients with T1 and T2 tumors and patients with a poor pathological response (TRG3, 4, 5) had a significantly higher LN harvest when undergoing a minimally invasive approach (p = 0.021 and p = 0.01, respectively). Positive LN rates (1.26 ± 3.63 in the MIE group vs. 1.60 ± 2.84 in the H/O group, p = 0.061), R0 rates (97% vs. 98.5%, p = 0.46) as well as proximal (p = 0.083), distal (p = 0.063), and lateral (p = 0.15) margins were comparable between both approaches.

Conclusion

MIE seems oncologically safe and may even be better than the open approach in terms of LN harvest especially in patients with T1 and T2 tumors and in poor responders.

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Abbreviations

ASA:

American Society of Anesthesiologists

MIE:

Minimally invasive esophagectomy

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Authors and Affiliations

  1. Department of Digestive, Oncologic and Metabolic Surgery, Institut Mutualiste Montsouris, Université de Paris, 42 Boulevard Jourdan, 75014, Paris, France

    Nicole Faermark, David Fuks, Alexandra Nassar, Jean-Marc Ferraz, Christian Lamer, Marine Lefevre, Brice Gayet & Stéphane Bonnet

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  1. Nicole Faermark
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  2. David Fuks
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  3. Alexandra Nassar
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Correspondence to Stéphane Bonnet.

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Drs. Faermark, Nassar, Ferraz, Lamer, and Lefevre as well as Profs. Fuks, Gayet, and Bonnet have no conflicts of interest or financial ties to disclose.

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Faermark, N., Fuks, D., Nassar, A. et al. Quality of oncological resection criteria in minimally invasive esophagectomy. Surg Endosc 36, 3940–3946 (2022). https://doi.org/10.1007/s00464-021-08713-6

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