Minimally invasive radical esophagectomy for patients with operable esophageal cancer / Mohamed Mohamed Rahouma Ahmed ; Supervised Abdelrahman Mohamed Abdelrahman , Nasser Khaled Altorki , Ahmed Osama Touny

Thesis (Ph.D.) - Cairo University - National Cancer Institute - Department of Oncology (Surgical)

Background: Esophageal cancer is ranked as the sixth leading cause of cancer deaths. Advances in surgery and minimally invasive esophagectomy (MIE) worth. Methods: We prospectively enrolled MIE cases done between May 2014 and October 2019 in Weill Cornell Medical Center aiming to assess short and long-term outcomes in addition to quality of life. Results: 69 esophagectomies were included. Eophageal cancer represents 13.9% of thoracic malignancy. Median age was 67 years. Almost 90% had tumors located in lower third /GEJ. Clinical stage I represents only 17.4% Adenocarcinoma represents 76.3%. 52 patients received induction therapy. Total and hybrid MIE were done in 63.8% and 36.2% respectively. Cervical anastomosis was done in 43.5%. Four cases were converted to thoracotomy (5.8%). Gastric conduit was used in all cases. Stapled anastomosis was done in 56.5%. Pathological complete response (PCR) was evident in 11 (15.9%) patients. Median proximal, distal and radial margins were 7.35, 5.30 and 0.60 cm respectively. Perioperative mortality was 2.9%. Anastmotic leak, pulmonary and cardiovascular complications occurred in 15.9%, 20.3% and 15.9% respectively. Compared to hybrid esophagectomy (n=25), total MIE (n=44) was associated with longer operation time and lower blood loss. Median and 3 years overall and disease fee survival were 38.8 months and 60.9% vs. 31.2 months and 46.7%. Performance status 1 and pathological N+ stage were associated with worse survival. Quality of life scores were better compared to preoperative assessment

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