340. LONG-TERM ONCOLOGIC OUTCOMES OF ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIATION AND SINGLE-INCISION MINIMALLY INVASIVE ESOPHAGECTOMY

Abstract

For locally advanced esophageal cancer, neoadjuvant chemoradiation therapy followed by esophagectomy is a widely accepted standard treatment. However, the preferable techniques for esophagectomy are still debatable. Multi-incision minimally invasive esophagectomy (MIE) had shown similar long-term oncologic outcomes with open esophagectomy, while it provided shorter hospital stay and less surgical pain due to its decreased wound size. Following the trend to minimize wounds, we developed single-incision MIE, with uniport thoracoscopy and single-incision laparoscopy. In this study, we presented the long-term oncologic outcomes of esophageal cancer after neoadjuvant chemoradiation and single-incision MIE and identified the risk factors for poor oncological outcomes. Materials and Methods: From 2008 to 2022, 573 patients with locally advanced esophageal cancer who received neoadjuvant chemoradiation followed by MIE at our institute were included. 254 of them underwent single-incision MIE. Kaplan–Meier analysis was used to calculate overall survival (OS) and progression free survival (PFS). Univariate and multivariate analyses were applied by Cox proportional hazard regression model. The 5-year OS of esophageal cancer with neoadjuvant chemoradiation and single-incision MIE was 62.5% (stage 0–1), 34.5% (stage 2), 31.1% (stage 3) and 13.1% (stage 4), while its 5-year PFS was 47.7% (stage 0–1), 33.2% (stage 2), 26.5% (stage 3) and 19.6% (stage 4) (Figure 1). For esophageal cancer treated with neoadjuvant chemoradiation and MIE, factors such as age ≤ 65, female, FEV1 > 80%, Single-incision MIE, operation time ≤ 500 min, lymph nodes retrieved>40, pathological cancer staging ≤2, clinical cancer staging ≤2 and negative resection margin were significantly predictive of improved overall survival (OS). After multivariate analysis, only age, FEV1, cancer staging (both pathological and clinical) and resection margin were independent risk factors for OS. For patients with advanced esophageal cancer, single-incision MIE after neoadjuvant chemoradiation is a feasible procedure with fair long-term oncological outcomes. Risk factors, such as age > 65, FEV1 ≤ 80%, pathological cancer staging >2, clinical cancer staging >2 and positive resection margin were independently predictive of poor OS.