Thoracoscopic-Assisted Esophagectomy for Esophageal Cancer
- 1 August 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 252 (2), 281-291
- https://doi.org/10.1097/sla.0b013e3181e909a2
Abstract
The authors report the recurrence pattern of esophageal cancer after thoracoscopic-assisted esophagectomy (TAE), comparing it to the recurrence pattern after open surgery and identify prognostic factors for recurrence. To improve long-term survival for esophageal cancer radical surgery has been proposed increasingly, however, recurrent disease remains a problem. Opinion is divided as to the adequacy of resection possible using minimally invasive techniques with concerns that there may be an increased incidence in locoregional recurrence. A total of 221 patients who underwent esophagectomy at the Princess Alexandra Hospital without any neoadjuvant or adjuvant therapy were identified from a prospective database. Patients were followed up for the detection of symptomatic recurrence for a median of 59 months. Within this group 165 patients underwent TAE and 56 an open transthoracic esophagectomy (TTE). The 5-year overall recurrence rate was 133/221 (60%). The 5-year rates of symptomatic first recurrence following TAE was 4%, 9%, and 47% for local, regional, and distant recurrence, respectively. The 5-year rates of symptomatic first recurrence following TTE was 5%, 18%, and 55% for local, regional, and distant recurrence, respectively. Operative approach was not a prognostic factor for any type of recurrence. Independent prognostic factors associated with locoregional recurrence were positive margins and number of positive nodes. Distant recurrence was associated with T stage, differentiation, tumor length >6 cm, and number of positive nodes. Distant recurrence remains a significant problem in esophageal cancer. TAE achieved adequate locoregional control and compared favorably with open TTE.Keywords
This publication has 34 references indexed in Scilit:
- Worldwide esophageal cancer collaborationDiseases of the Esophagus, 2009
- Comparison of the Outcomes Between Open and Minimally Invasive EsophagectomyAnnals of Surgery, 2007
- Minimally invasive esophagectomySurgical Endoscopy, 2005
- High volume centers for esophagectomy: what is the number needed to achieve low postoperative mortality?Diseases of the Esophagus, 2004
- Clinical response to induction chemotherapy predicts local control and long-term survival in multimodal treatment of patients with locally advanced esophageal cancerZeitschrift für Krebsforschung und Klinische Onkologie, 2004
- Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent diseaseCancer, 2003
- Three-Field Lymph Node Dissection for Squamous Cell and Adenocarcinoma of the EsophagusAnnals of Surgery, 2002
- Circumferential resection margin involvement: an independent predictor of survival following surgery for oesophageal cancerGut, 2001
- Effect of microscopic resection line disease on gastric cancer survivalJournal of Gastrointestinal Surgery, 1999
- Significance of circumferential resection margin involvement after oesophagectomy for cancerBritish Journal of Surgery, 1993