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Review
. 2022 Feb 25;20(1):50.
doi: 10.1186/s12957-022-02518-0.

Long-term survival outcomes of esophageal cancer after minimally invasive Ivor Lewis esophagectomy

Keouna Pather  1   2 , Erin M Mobley  3 , Christina Guerrier  3 , Rhemar Esma  4 , Heather Kendall  4 , Ziad T Awad  3
Affiliations
Review

Long-term survival outcomes of esophageal cancer after minimally invasive Ivor Lewis esophagectomy

Keouna Pather et al. World J Surg Oncol. .

Abstract

Objectives: The aim of this study was to determine the long-term overall and disease-free survival and factors associated with overall survival in patients with esophageal cancer undergoing a totally minimally invasive Ivor Lewis esophagectomy (MILE) at a safety-net hospital.

Methods: This was a single-center retrospective review of consecutive patients who underwent MILE from September 2013 to November 2017. Overall and disease-free survival were analyzed by Kaplan-Meier estimates, and hazard ratios (HR) were derived from multivariable Cox regression models.

Results: Ninety-six patients underwent MILE during the study period. Overall survival at 1, 3, and 5 years was 83.2%, 61.9%, and 55.9%, respectively. Disease-free survival at 1, 3, and 5 years was 83.2%, 60.6%, and 47.5%, respectively. Overall survival (p < 0.001) and disease-free survival (p < 0.001) differed across pathological stages. By multivariable analysis, increasing age (HR, 1.06; p = 0.02), decreasing Karnofsky performance status score (HR, 0.94; p = 0.002), presence of stage IV disease (HR, 5.62; p = 0.002), locoregional recurrence (HR, 2.94; p = 0.03), and distant recurrence (HR, 4.78; p < 0.001) were negatively associated with overall survival. Overall survival significantly declined within 2 years and was independently associated with stage IV disease (HR, 3.29; p = 0.04) and distant recurrence (HR, 5.78; p < 0.001).

Conclusion: MILE offers favorable long-term overall and disease-free survival outcomes. Age, Karnofsky performance status score, stage IV, and disease recurrence are shown to be prognostic factors of overall survival. Prospective studies comparing long-term outcomes after different MIE approaches are warranted to validate survival outcomes after MILE.

Keywords: Cancer survival; Esophageal malignancy; Ivor Lewis esophagectomy; Thoracic surgery; Thoracolaparoscopic esophagectomy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier estimates of overall survival in 96 patients
Fig. 2
Fig. 2
Kaplan-Meier estimates of disease-free survival in 96 patients
Fig. 3
Fig. 3
Kaplan-Meier estimates of (A) overall survival and (B) disease-free survival stratified by pathological stage 0–IV
Fig. 4
Fig. 4
Kaplan-Meier estimates of (A) overall survival and (B) disease-free survival stratified by esophageal cancer type
See this image and copyright information in PMC

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