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Initial Results of Minimally Invasive Ivor Lewis Esophagectomy After Induction Chemoradiation (50.4 Gy) for Esophageal Cancer

Thomay, Alan A. MD*; Snyder, Justin A. DO; Edmondson, Donna M. MSN, CRNP; Scott, Walter J. MD

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery: November/December 2012 - Volume 7 - Issue 6 - p 421–428
doi: 10.1097/IMI.0b013e31828130b7
Original Articles

Objective: Esophageal cancer patients receiving induction chemoradiation to 41 Gy randomized to minimally invasive (MIS) esophagectomy have fewer postoperative pulmonary complications compared with those who underwent open procedures. We evaluated the feasibility of MIS Ivor Lewis esophagectomy in patients treated with induction chemoradiation to 50.4 Gy.

Methods: We retrospectively analyzed clinical data from 30 consecutive patients undergoing MIS Ivor Lewis esophagectomy after induction chemoradiation to a mean dose of 50.4 Gy by a single surgeon at a tertiary institution since 2010. Data collected included patient demographics, preoperative risk factors, neoadjuvant treatment modalities, histology, staging, operative factors, and perioperative complications.

Results: The mean age of the patients was 61 ± 9.5 years, and 87% were men. The dominant histology was adenocarcinoma (90%), with most tumors (70%) located at the gastroesophageal junction. A total of 22 patients (73%) presented with dysphagia, but only 15 (50%) had associated weight loss (mean 12.2% total body mass). All patients had R0 resections; mean number of resected lymph nodes was 27.1 ± 11.4. Mean operating room time was 535 ± 120 minutes, with the last 10 operations 2 hours shorter than the preceding 20. Four patients (13.3%) had major complications. including 2 (6.7%) anastomotic leaks. There was no operative mortality.

Conclusions: Minimally invasive Ivor Lewis esophagectomy after chemoradiation to 50.4 Gy can be performed with decreased morbidity and mortality compared with historical series of open Ivor Lewis esophagectomy. Oncologic outcomes were acceptable as demonstrated by lymph node retrieval and complete resection rates. Operative time decreased significantly after 20 cases.

From the *Department of Surgical Oncology and †Division of Thoracic Surgery, Fox Chase Cancer Center, Philadelphia, PA USA.

Accepted for publication November 26, 2012.

A.A. Thomay and J.A. Snyder contributed equally to this work.

Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, May 30 – June 2, 2012, Los Angeles, CA USA.

Disclosures: Walter J. Scott, MD, is a shareholder in Johnson & Johnson, Cincinnati, OH USA, Celgene Corp, Summit, NJ USA, and Biogen, Weston, MA USA, and has been a consultant for Covidien, Mansfield, MA USA. Alan A. Thomay, MD, Justin A. Snyder, DO, and Donna M. Edmondson, MSN, CRNP, declare no conflict of interest.

Address correspondence and reprint requests to Walter J. Scott, MD, Division of Thoracic Surgery, Fox Chase Cancer Center, 333 Cottman Avenue, C312, Philadelphia, PA 19111-2497 USA. E-mail:

Copyright © 2012 by the International Society for Minimally Invasive Cardiothoracic Surgery. Unauthorized reproduction of this article is prohibited.