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Tankel J, Ahmed N, Mueller C, Najmeh S, Spicer J, Mulder D, Cool-Lartigue J, Rousseau M, Frechette D, Sud S, Kavan P, Moghrabi A, Champagne M, Lemay F, Dalfen R, Sirhan S, Asselah J, Alcindor T, Ferri L. Docetaxel-Based Neoadjuvant Chemotherapy Followed by En Bloc Resection for Esophageal Adenocarcinoma: A 15-Year Retrospective Analysis from a Regional Upper Gastrointestinal Cancer Network. Ann Surg Oncol 2024; 31:2461-2469. [PMID: 38142255 DOI: 10.1245/s10434-023-14779-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/30/2023] [Indexed: 12/25/2023]
Abstract
BACKROUND Real-world, long-term survival outcomes of neoadjuvant, docetaxel-based therapy for esophageal and junctional adenocarcinoma are lacking. This study describes the long-term survival outcomes of patients with esophageal and junctional adenocarcinoma treated with neoadjuvant docetaxel-based chemotherapy and en bloc transthoracic esophagectomy. METHODS A retrospective cohort analysis of a prospectively maintained database from a regional upper gastrointestinal cancer network in Quebec, Canada, was performed. From January 2007 to December 2021, all patients with locally advanced (cT3 and/or N1) esophageal/Siewert I/II adenocarcinoma treated with neoadjuvant DCFx3 (Docetaxel/Cisplatin/5FU) or FLOTx4 (5FU/Leucovorin/Oxaliplatin/Docetaxel) and transthoracic en bloc esophagectomy were identified. Postoperative, pathological, and survival outcomes were compared. RESULTS Overall, 236 of 420 patients met the inclusion criteria. Tumor location was esophageal/Siewert I/Siewert II (118/33/85), most were cT3-4 (93.6%) and cN+ (61.0%). DCF and FLOT were used in 127 of 236 (53.8%) and 109 of 236 (46.2%). All neoadjuvant cycles were completed in 87.3% with no difference between the regimens. Operative procedures included Ivor Lewis (81.8%), left thoraco-abdominal esophagectomy (10.6%) and McKeown (7.6%) with an R0 resection in 95.3% and pathological complete response in 9.7% (DCF 12.6%/FLOT 6.4%, p = 0.111). The median lymph node yield was 32 (range 4-79), and 60.6% were ypN+. Median follow-up was longer for the DCF group (74.8 months 95% confidence interval [CI] 4-173 vs. 37.8 months 95% CI 2-119, p <0.001. Overall survival was similar between the groups (FLOT 97.3 months, 78.6-115.8 vs. DCF 92.9, 9.2-106.5, p = 0.420). CONCLUSIONS Neoadjuvant DCF and FLOT followed by transthoracic en bloc resection are both highly effective regimens for locally advanced esophageal adenocarcinoma with equivalent survival outcomes despite high disease load.
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Affiliation(s)
- James Tankel
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Nabeel Ahmed
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Carmen Mueller
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Sarah Najmeh
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Jonathan Spicer
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - David Mulder
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Jonathan Cool-Lartigue
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Mathieu Rousseau
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada
| | | | - Shelly Sud
- Department of Medical Oncology, Hopital de Gatineau, Gatineau, QC, Canada
| | - Petr Kavan
- Deparment of Oncology, Jewish General Hospital, Montreal, QC, Canada
| | - Albert Moghrabi
- Department of Oncology, Hopital de Verdun, Montreal, QC, Canada
| | | | - Frederic Lemay
- Deparmtent of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Richard Dalfen
- Division of Medical Oncology, St Mary's Hospital Center, Montreal, QC, Canada
| | - Shireen Sirhan
- Department of Oncology, Brome-Missisquoi-Perkins, Cowansville, QC, Canada
| | - Jamil Asselah
- Division of Medical Oncology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Thierry Alcindor
- Division of Medical Oncology, Royal Victoria Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Lorenzo Ferri
- Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC, Canada.
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Janssen HJB, Geraedts TCM, Simkens GA, Visser M, de Hingh IHJT, van Det MJ, Nieuwenhuijzen GAP, van Hillegersberg R, Luyer MDP, Nienhuijs SW. The impact of hospital experience in bariatric surgery on short-term outcomes after minimally invasive esophagectomy: a nationwide analysis. Surg Endosc 2024; 38:720-734. [PMID: 38040832 DOI: 10.1007/s00464-023-10560-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/22/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Minimally invasive esophagectomy (MIE) is a technically challenging procedure with a substantial learning curve. Composite volume of upper gastrointestinal (upper GI) procedures for cancer has been previously linked to postoperative outcomes. This study aimed to investigate an association between hospital experience in bariatric surgery and short-term outcomes in MIE. METHOD Data on esophagectomy patients between 2016 and 2020 were collected from the Dutch Upper Gastrointestinal Cancer Audit, a mandatory nationwide registry. Hospitals were categorized as bariatric or non-bariatric. Multivariable logistic regression investigated short-term postoperative outcomes, adjusting for case mix. RESULTS Of 3371 patients undergoing esophagectomy in sixteen hospitals, 2450 (72.7%) underwent MIE. Bariatric hospitals (N = 6) accounted for 1057 (43.1%) MIE. Annual volume of bariatric procedures was median 523 and esophagectomies 42. In non-bariatric hospitals, volume of esophagectomies was median 52 (P = 0.145). Overall postoperative complication rate was lower in bariatric hospitals (59.2% vs. 65.9%, P < 0.001). Bariatric hospitals were associated with a reduced risk of overall complications (aOR 0.76 [95% CI 0.62-0.92]), length of hospital (aOR 0.79 [95% CI 0.65-0.95]), and ICU stay (aOR 0.81 [95% CI 0.67-0.98]) after MIE. Surgical radicality (R0) did not differ. Lymph node yield (≥ 15) was lower in bariatric hospitals (90.0% vs. 94.7%, P < 0.001). Over the years, several short-term outcomes improved in bariatric hospitals compared to non-bariatric hospitals. CONCLUSION In this nationwide analysis, there was an association between bariatric hospitals and improved short-term outcomes after MIE. Characteristics of bariatric hospitals that could explain this phenomenon and whether this translates to other upper GI procedures may be warranted to identify.
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Affiliation(s)
- Henricus J B Janssen
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Tessa C M Geraedts
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Geert A Simkens
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
- Department of Cancer and Surgery, Imperial College London, London, UK
| | - Maurits Visser
- Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Ignace H J T de Hingh
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Marc J van Det
- Department of Surgery, ZGT Hospital Group Twente, Almelo, The Netherlands
| | - Grard A P Nieuwenhuijzen
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | | | - Misha D P Luyer
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
- Department of Electrical Engineering, University of Technology Eindhoven, Eindhoven, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Abstract
Esophagectomy is the gold standard for the treatment of resectable esophageal cancer. Traditionally, it is performed through a laparotomy and a thoracotomy, and is associated with high rates of postoperative complications and mortality. The advent of robotic surgery has represented a technological evolution in the field of esophageal cancer treatment. Robot-assisted Minimally Invasive Esophagectomy (RAMIE) has been progressively widely adopted following the first reports on the safety and feasibility of this procedure in 2004. The robotic approach has better short-term postoperative outcomes than open esophagectomy, without jeopardizing oncologic radicality. The results of the comparison between RAMIE and conventional minimally invasive esophagectomy are less conclusive. This article will focus on the role of RAMIE in the current clinical scenario with particular attention to its possible benefits and perspectives.
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Affiliation(s)
| | - Elettra Ugliono
- Department of Surgical Sciences, University of Turin, Torino, Italy
| | | | - Mario Morino
- Department of Surgical Sciences, University of Turin, Torino, Italy
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Triantafyllou T, van der Sluis P, Skipworth R, Wijnhoven BPL. The Implementation of Minimally Invasive Surgery in the Treatment of Esophageal Cancer: A Step Toward Better Outcomes? Oncol Ther 2022; 10:337-349. [PMID: 35945401 PMCID: PMC9681954 DOI: 10.1007/s40487-022-00206-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/21/2022] [Indexed: 11/26/2022] Open
Abstract
Esophagectomy is considered the cornerstone of the radical treatment of esophageal cancer. In the past decades, minimally invasive techniques including robot-assisted approaches have become popular. The aim of minimally invasive surgery is to reduce the surgical trauma, resulting in faster recovery, reduction in complications, and better quality of life after surgery. Secondly, a more precise dissection may lead to better oncological outcomes. As such, minimally invasive esophagectomy is now seen by many as the standard surgical approach. However, evidence supporting this viewpoint is limited. This narrative review summarizes recent prospectively designed studies on minimally invasive esophagectomy.
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Affiliation(s)
- Tania Triantafyllou
- Upper Gastrointestinal Surgical Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Pieter van der Sluis
- Upper Gastrointestinal Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Richard Skipworth
- Upper Gastrointestinal Surgical Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Bas P L Wijnhoven
- Upper Gastrointestinal Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
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Jiang X, Xu X, Ding L, Zhu H, Lu J, Zhao K, Zhu S, Xu Q. Predictive value of preoperative handgrip strength on postoperative outcomes in patients with gastrointestinal tumors: a systematic review and meta-analysis. Support Care Cancer 2022; 30:6451-6462. [PMID: 35316404 DOI: 10.1007/s00520-022-06983-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/11/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE This systematic review and meta-analysis aimed to explore the predictive value of preoperative handgrip strength on postoperative outcomes in patients with gastrointestinal tumors. METHODS Databases including Cochrane Library, Pubmed, Embase, Web of Science, and CINAHL Complete were searched for articles published from the establishment of database until August 7, 2021. Two researchers independently screened the literature, extracted the data, and evaluated the quality. RESULTS Eight studies were included, involving five prospective and three retrospective cohort studies with 2291 participants. The prevalence of preoperative low handgrip strength ranged from 11.8 to 62.7%. Preoperative low handgrip strength was associated with an increased risk of total complications (OR = 2.23, 95%CI = 1.43-3.50), pneumonia (OR = 5.16, 95%CI = 3.17-8.38), ileus (OR = 2.48, 95%CI = 1.09-5.65), and short-term mortality (OR = 7.28, 95%CI = 1.90-27.92). CONCLUSION This systematic review and meta-analysis indicated that preoperative HGS had important value to predict certain adverse postoperative outcomes among patients with GI tumors. Low handgrip strength criteria, definition of total complications, and country are the potential sources of heterogeneity, and more research are required to test and update these results.
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Affiliation(s)
- Xiaoman Jiang
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Xinyi Xu
- Faculty of Health, Queensland University of Technology, Brisbane, 4702, Australia
| | - Lingyu Ding
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Jinling Lu
- Department of Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 211166, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Shuqin Zhu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China.
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