Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 May;28(5):2730-2738.
doi: 10.1245/s10434-020-09425-2. Epub 2020 Dec 19.

Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy

I L Defize #  1   2 , S van der Horst #  1 , M Bülbul  3 , N Haj Mohammad  4 , S Mook  2 , G J Meijer  2 , L A A Brosens  5 , J P Ruurda  1 , R van Hillegersberg  6
Affiliations

Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy

I L Defize et al. Ann Surg Oncol. 2021 May.

Abstract

Background: Patients with esophageal cancer that invades adjacent structures (cT4b) are precluded from surgery and usually treated with definitive chemoradiotherapy (dCRT). dCRT might result in sufficient downstaging to enable a radical resection, possibly improving survival. This study aimed to assess the perioperative and oncologic outcomes of a salvage robot-assisted minimally invasive esophagectomy (RAMIE) in patients with cT4b esophageal cancer after dCRT.

Methods: Between June 2012 and November 2019, patients who underwent a RAMIE with a gastric conduit reconstruction after completion of dCRT for cT4b esophageal carcinoma were identified from a prospectively maintained surgical database at the University Medical Center Utrecht.

Results: In total, 24 patients with a histopathologically confirmed T4b adenocarcinoma or squamous cell carcinoma of the esophagus were included. The adjacent organs involved were the tracheobronchial tree (67%), aorta (21%) or both (13%). No conversions or major intraoperative complications were observed. A radical resection was achieved in 22 patients (92%), and a pathologic complete response was observed in 13 (54%) patients. Postoperative grade 2 or higher complications occurred in 20 patients (83%). The disease-free survival at 24 months was 68% for the patients in whom a radical resection was achieved.

Conclusion: In patients with cT4b esophageal cancer treated with dCRT followed by a salvage RAMIE, a radical resection rate of 92% was achieved, with acceptable complications and promising survival rates. These results demonstrate the feasibility of a curative surgical treatment for patients with initially irresectable esophageal cancer but underscore the importance of a proper preoperative patient selection.

PubMed Disclaimer

Conflict of interest statement

J. P. Ruurda and R. van Hillegersberg are proctors for Intuitive Surgical Inc, Sunnyvale, CA. The remaining authors have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flowchart of cT4b patients with an indication for surgical resection with curative intent through Robot Assisted Minimally Invasive Esophagectomy (RAMIE). dCRT definitive chemoradiotherapy, MDT multi-disciplinary team, RAMIE robot assisted minimally invasive esophagectomy, UES upper esophageal sphincter, a observed on PET-CT, EBUS and/or EUS
Fig. 2
Fig. 2
Kaplan Meier curves of the overall survival and disease free survival. a Overall survival of patients who underwent a salvage RAMIE (blue line) and patients who did not proceed to surgery after definitive chemoradiotherapy (red line), b Disease free survival of patients in whom a radical (R0) resection was achieved; RAMIE robot assisted minimally invasive esophagectomy
See this image and copyright information in PMC

References

    1. Makino T, Yamasaki M, Tanaka K, et al. Treatment and clinical outcome of clinical T4 esophageal cancer: a systematic review. Ann Gastroenterol Surg. 2019;3:169–180. doi: 10.1002/ags3.12222. - DOI - PMC - PubMed
    1. Gwynne S, Hurt C, Evans M, Holden C, Vout L, Crosby T. Definitive chemoradiation for oesophageal cancer; a standard of care in patients with non-metastatic oesophageal cancer. Clin Oncol. 2011;23:182–188. doi: 10.1016/j.clon.2010.12.001. - DOI - PubMed
    1. Reid TD, Davies IL, Mason J, Roberts SA, Crosby TDL, Lewis WG. Stage-for-stage comparison of recurrence patterns after definitive chemoradiotherapy or surgery for oesophageal carcinoma. Clin Oncol. 2012;24:617–624. doi: 10.1016/j.clon.2012.02.001. - DOI - PubMed
    1. Fujita H, Sueyoshi S, Tanaka T, et al. Esophagectomy: is it necessary after chemoradiotherapy for a locally advanced T4 esophageal cancer? Prospective nonrandomized trial comparing chemoradiotherapy with surgery versus without surgery. World J Surg. 2005;29:25–31. doi: 10.1007/s00268-004-7590-2. - DOI - PubMed
    1. Seto Y, Chin K, Gomi K, et al. Treatment of thoracic esophageal carcinoma invading adjacent structures. Cancer Sci. 2007;98:937–942. doi: 10.1111/j.1349-7006.2007.00479.x. - DOI - PMC - PubMed