Long term oncologic outcomes following minimally invasive resection for oesophago-gastric cancer.


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Esther Platt1,Esther Platt1,Deepali Prakash2,Darmarajah Veeramootoo3,Saj Wajed2
1Derriford Hospital NHS Trust,2Royal Devon and Exeter NHS Foundation Trust,3Frimley Health NHS Foundation Trust

Abstract

Background

Surgical resection of oesophago-gastric cancer remains the only option for curative treatment in patients without systemic disease. The introduction of the minimally invasive oesophagectomy, based on limiting the trauma of access, has provided an alternative to traditional open surgery.  Adoption of this technique has been cautious, due to concerns regarding morbidity and mortality, and a perceived limited resection field. There is, however, a growing body of evidence to support comparable peri-operative outcomes, resection margins and lymph node yield.  Long term data to establish survival equivalency is still lacking.  We present a completed five year follow up on patients treated with a minimally invasive oesophagectomy.

Method

The technique was adopted and further developed in our centre from 2004 to 2010, utilising a combined thoracoscopic/laparoscopic approach and two-field lymphadenectomy.  Data was prospectively collected on consecutive patients, to include patient demographics, stage of cancer, peri-operative outcomes, lymph node yield and long term follow up.

Results

In total 156 patients underwent a resection; 25 had a one stage minimally invasive and 131 patients underwent a totally minimally invasive oesophagectomy (Total MIO).  98 (75%) patients received neo-adjuvant chemotherapy as per standard UK protocol.  Median lymph node yield was 20 (range 0-63).  Overall 5 year survival for this cohort was 37%. Stage specific survival was stage 1 – 60%, stage 2 – 36% and stage 3 - 17%. R0 resection was achieved in 96% cases and recurrence occurred in 53 patients.  Overall disease free survival at 5 years was 33%.  Stage specific disease survival was stage 1 - 58%, 2 - 34% and stage 3 - 10%.

Conclusion

Minimally Invasive Oesophagectomy has comparable long term oncologic outcomes to traditional open surgery and represents a viable treatment option in selected patients.