Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?

BACKGROUND

Few studies reported the outcomes of minimally invasive esophagectomy (MIE) in treating patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (nCRT). The aim of the study was to investigate the feasibility and efficacy of nCRT plus MIE (RM) strategy in treating locally advanced resectable ESCC.

METHODS

This retrospective study included 175 patients with ESCC undergoing surgical resection after neoadjuvant therapy in our institution from 2010 to 2016. Patients were stratified into three groups: RM, [neoadjuvant chemotherapy (nCT) plus MIE] (CM) and [nCT plus open esophagectomy (OE)] (CO).

RESULTS

Seventy-six (43.4%), 42 (24%) and 57 (32.6%) patients received RM, CM and CO approach, respectively. Compared with CO approach, RM or CM approach had shorter operation duration (188±39, 185±37 209±45 minutes, P=0.004, P=0.009) and less blood loss (124±88, 122±79 166±92 mL, P=0.001, P=0.003). There was a trend with lower risk of postoperative non-surgical complications in RM and CM approach [odds ratio (OR) 0.45, 0.200-1.040; P=0.062; OR 0.41, 0.150-1.160; P=0.093]. There were no differences in 30- and 90-day mortality among all groups. RM approach was more likely to achieve pathological complete regression (27.6% 4.8%, 1.8%, P=0.001, P=0.001) and fewer lymph node metastasis (25.0% 57.1%, 61.4%, P=0.001, P=0.001) than CM or CO approach. Survival analysis revealed a potential trend towards improved overall survival in RM approach compared with CM or CO approach (P=0.098, P=0.166).

CONCLUSIONS

RM approach was a safe and efficient strategy in treating locally advanced resectable ESCC.