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- Title
Comparative analysis of long-term oncologic outcomes for minimally invasive and open Ivor Lewis esophagectomy after neoadjuvant chemoradiation: a propensity score matched observational study.
- Authors
Merritt, Robert E.; Kneuertz, Peter J.; Abdel-Rasoul, Mahmoud; D'Souza, Desmond M.; Perry, Kyle A.
- Abstract
<bold>Background: </bold>Locally advanced esophageal carcinoma is typically treated with neoadjuvant chemoradiation and esophagectomy (trimodality therapy). We compared the long-term oncologic outcomes of minimally invasive Ivor Lewis esophagectomy (M-ILE) cohort with a propensity score weighted cohort of open Ivor Lewis esophagectomy (O-ILE) cases after trimodality therapy.<bold>Methods: </bold>This is a retrospective review of 223 patients diagnosed with esophageal carcinoma who underwent neoadjuvant chemoradiation followed by M-ILE or O-ILE from April 2009 to February 2019. Inverse probability of treatment weighting (IPTW) adjustment was used to balance the baseline characteristics between study groups. Kaplan-Meier survival curves were calculated for overall survival and recurrence-free survival comparing the two groups. Multivariate Cox proportional hazards regression models were used to determine predictive variables for overall and recurrence-free survival.<bold>Results: </bold>The IPTW cohort included patients with esophageal carcinoma who underwent M-ILE (n = 142) or O-ILE (n = 68). The overall rate of postoperative adverse events was not significantly different after IPTW adjustment between the O-ILE and M-ILE trimodality groups (53.4% vs. 39.2%, p = 0.089). The 3-year overall survival (OS) for the M-ILE group was 59.4% (95% CI: 49.8-67.8) compared to 55.7% (95% CI: 39.2-69.4) for the O-ILE group (p = 0.670). The 3-year recurrence-free survival for the M-ILE group was 59.9% (95% CI: 50.2-68.2) compared to 61.6% (95% CI: 41.9-76.3) for the O-ILE group (p = 0.357). A complete response to neoadjuvant chemoradiation was significantly predictive of improved OS and RFS.<bold>Conclusion: </bold>The overall and recurrence-free survival rates for M-ILE were not significantly different from O-ILE for esophageal carcinoma after trimodality therapy. Complete response to neoadjuvant chemoradiation was predictive of improved overall and recurrence- free survival.
- Subjects
CHEMORADIOTHERAPY; ESOPHAGEAL cancer; RECTAL cancer; PROPENSITY score matching; PROPORTIONAL hazards models; OVERALL survival; ESOPHAGECTOMY; SURVIVAL rate; ENDOSCOPIC surgery; RETROSPECTIVE studies; DIGESTIVE organ surgery; COMBINED modality therapy; PROBABILITY theory
- Publication
Journal of Cardiothoracic Surgery, 2021, Vol 16, Issue 1, p1
- ISSN
1749-8090
- Publication type
journal article
- DOI
10.1186/s13019-021-01728-z