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Observational Study
. 2021 Dec 6;16(1):347.
doi: 10.1186/s13019-021-01728-z.

Comparative analysis of long-term oncologic outcomes for minimally invasive and open Ivor Lewis esophagectomy after neoadjuvant chemoradiation: a propensity score matched observational study

Robert E Merritt  1 , Peter J Kneuertz  2 , Mahmoud Abdel-Rasoul  3 , Desmond M D'Souza  2 , Kyle A Perry  4
Affiliations
Observational Study

Comparative analysis of long-term oncologic outcomes for minimally invasive and open Ivor Lewis esophagectomy after neoadjuvant chemoradiation: a propensity score matched observational study

Robert E Merritt et al. J Cardiothorac Surg. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Esophageal carcinoma; Ivor Lewis esophagectomy; Minimally invasive esophagectomy; Neoadjuvant therapy.

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Conflict of interest statement

The authors declare that they have no competing interests regarding the preparation of this manuscript.

Figures

Fig. 1
Fig. 1
CONSORT diagram for patient selection and allocation
Fig. 2
Fig. 2
Kaplan Meier Curves for comparison of Overall Survival between minimally invasive (M-ILE) and open (O-ILE) Ivor Lewis esophagectomy after neoadjuvant chemoradiation
Fig. 3
Fig. 3
Kaplan Meier Curves for comparison of Recurrence-Free Survival between minimally invasive (M-ILE) and open (O-ILE) Ivor Lewis esophagectomy after neoadjuvant chemoradiation
See this image and copyright information in PMC

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