603. Thoracoscopic esophagectomy with total mediastinal lymphadenectomy in esophageal cancer patients with near complete response to neoadjuvant chemoradiotherapy: Feasibility and significance

2016 ◽  
Vol 42 (9) ◽  
pp. S180
Author(s):  
R. Kalayarasan
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Thoracoscopic Esophagectomy ◽  
Mediastinal Lymphadenectomy

761 PATIENT PREFERENCES FOR ACTIVE SURVEILLANCE VERSUS STANDARD SURGERY AFTER NEOADJUVANT CHEMORADIOTHERAPY IN ESOPHAGEAL CANCER TREATMENT

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Merel Hermus ◽  
Berend Wilk ◽  
Gerlise Collee ◽  
Rebecca Chang ◽  
Bo Noordman ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Active Surveillance ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Treatment Preference ◽  
Patient Treatment ◽  
Treatment Preferences ◽  
Future Health ◽  
Depth Interviews

Abstract   The need for standard surgical resection in esophageal cancer patients after neoadjuvant chemoradiotherapy (nCRT) is subject of debate. Possibly, active surveillance (AS) is an option for patients with a clinically complete response (cCR), in whom no vital tumor cells are detected after nCRT. In a large Dutch multicenter randomized trial (SANO trial), standard surgery is compared to AS in patients with a cCR. Within this trial, we performed a side-study on patient treatment preferences. Methods Esophageal cancer patients, who declined participation in the SANO-trial due to a strong treatment preference for either AS or surgery were included. In-depth interviews were held on patient’s motives for their treatment choice. First, personal motives were addressed in an open manner, and later specific topics were addressed: earlier experiences with illness and health care, future health expectations, emotional motives, religious or spiritual believes and values in life. Data was recorded, transcribed verbatim and qualitatively analyzed according to the grounded theory principles. In addition, questionnaires on health literacy, coping, anxiety and decision regret were administered at two time points. Results Forty patients participated: twenty preferred AS and twenty standard surgery. The central principle for all patients is striving for safety while dealing with the threat of cancer. However, patients express different coping strategies in dealing with this threat. Patients preferring AS rely on trusting their bodies and good outcomes, while questioning the need for surgery. Patients preferring surgery try to minimize insecurity by eliminating the source of the cancer, while arguing that chances for undergoing surgery are high anyway. Interestingly, for either treatment option comparable arguments were used, with the most striking one of wishing ‘not to become a patient’. Conclusion Patients’ preferences in the treatment of esophageal cancer are determined by the way they cope with the threat of cancer. Since the arguments given for either AS or standard surgery can be comparable or even similar, the need for healthcare professionals to discuss what truly matters to their patients is of high importance. Subsequently, attuning to the personal needs of esophageal cancer patients will benefit the decision making process on future treatment.

Su1618 Restaging PET-CT After Neoadjuvant Chemoradiotherapy Can Prevent Non-Curative Surgical Interventions in Esophageal Cancer Patients

2013 ◽  
Vol 144 (5) ◽  
pp. S-1075
Author(s):  
Martinus C. Anderegg ◽  
Roelof J. Bennink ◽  
Hanneke van Laarhoven ◽  
Jean H. Klinkenbijl ◽  
Maarten C. Hulshof ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Neoadjuvant Chemoradiotherapy ◽  
Surgical Interventions ◽  
Pet Ct

PS02.249: VARIATION IN BODY COMPOSITION IN ESOPHAGEAL CANCER PATIENTS RECEIVING SUPPLEMENTARY JEJUNOSTOMY FEEDING DURING NEOADJUVANT CHEMORADIOTHERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 194-194
Author(s):  
Piers R Boshier ◽  
M F J Seesing ◽  
Vickie E Baracos ◽  
Donald E Low
Keyword(s):  
Esophageal Cancer ◽  
Body Composition ◽  
Cancer Patients ◽  
Neoadjuvant Chemoradiotherapy ◽  
The Body ◽  
Tissue Loss ◽  
Tube Placement ◽  
Average Weight ◽  
Term Survival ◽  
Jejunostomy Feeding

Abstract Background Cancer of the esophagus has one of the highest known associations with cancer–related malnutrition. The aim of the current study was to investigate variation in the body composition of esophageal cancer patients receiving supplementary jejunostomy feeding during neoadjuvant chemoradiotherapy (nCRT) and to assess its correlation with outcomes. Methods Retrospective review of esophageal cancer patient's receiving jejunal feeding during nCRT. Patients selected for jejunal feeding tube placement were considered at high nutritional risk according to ASPEN criteria. Assessment of body composition was performed using L3-axial CT images acquired at diagnosis and after nCRT. Results Eighty-one patients were eligible for inclusion (67 M, 65.9 ± 9.7 yrs). Average weight loss and BMI at diagnosis was 11.4 ± 6.5 Kg and 26.1 ± 4.6 Kg/m2 respectively. Failure to complete nCRT as prescribed occurred in one patient. Following nCRT the prevalence of sarcopenia increased significantly in males despite jejunal feeding (69% vs. 87%; P = 0.013) but fell in females (57% vs. 50%; P = 0.705). Patients could be categorized into three distinct groups according to the degree of skeletal muscle loss (ΔSMM) during nCRT: minor-loss/no-change (n = 28; Δ > −6 cm2); moderate loss (n = 27; Δ−17 to −6 cm2), and; severe loss (n = 26; Δ<17 cm2). A female predominance was observed amongst patients with minor-loss/no-change in SMM compared to patients with moderate and severe losses during nCRT (36% vs. 11% vs. 4%; P = 0.005). Visceral obesity was also less common in patients with minor-loss/no-change in SMM compared to patients with moderate and severe losses during nCRT (39% vs. 48% vs. 58%; P = 0.401). Compared to patients with moderate and severe SMM losses patients in whom SMM was persevered by jejunal feeding during nCRT tended to have lower rates of over-all complications (62% vs. 59% vs. 43%; P = 0.318); pneumonia (27% vs. 11% vs. 11%; P = 0.186), and; pulmonary embolism (15% vs. 0% vs. 0%; P = 0.012). Long-term survival was not affected by either sarcopenia or SMM and adipose tissue loss during nCRT (P > 0.05). Conclusion This is the first study to report variation in body composition in esophageal cancer patients receiving a defined nutritional intervention during nCRT. In selected patients jejunal feeding appeared to stabilize parameters of body composition whilst other patients experienced significant losses. Observed changes in body composition predominantly reflect sex differences and may offer an opportunity to improve nutritional monitoring and future patient care. Disclosure All authors have declared no conflicts of interest.

PS02.016: MINIMALLY INVASIVE ESOPHAGECTOMY IN ESOPHAGEAL CANCER: EXPERIENCE IN THE FIRST 100 CASES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 124-125
Author(s):  
Atila Eroglu ◽  
Coskun Daharli ◽  
Yener Aydin ◽  
Ali Ulas ◽  
Haci Alici
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Minimally Invasive Esophagectomy ◽  
Cell Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Thoracoscopic Esophagectomy ◽  
Invasive Esophagectomy ◽  
The Mean

Abstract Background In this study, the efficiency of minimally invasive esophagectomy in esophageal cancer was examined. Methods A total of 100 consecutive patients who were hospitalized due to esophageal cancer and planned minimally invasive esophagectomy were evaluated prospectively between September 2013 and December 2017 in our clinic. Laparoscopic and thoracoscopic esophagectomy was performed in all of the patients included in the study. Inoperable cases were not included in the study. Age and sex of the patients, symptoms, localization of tumor, histopathological type, surgical modality, operation time, length of hospital stay and morbidity and mortality rates were reviewed. Results Thirty-eight (38%) patients were male and 62 (62%) patients were female. The mean age was 55.5 ± 10.8 (32–75 years). The most symptoms were dysphagy (96%) and weight loss (39%). Eighty-one patients (81%) had squamous cell cancer, ten (10%) had adenocarcinoma and nine had another form of esophageal cancer. Neoadjuvant chemoradiotherapy was performed in 36 of the 100 patients. Laparoscopic and thoracoscopic esophagectomy and intrathoracic anastomosis were performed in 94 patients (94%). Laparoscopic and thoracoscopic esophagectomy and neck anastomosis were performed in six patients (6%). The mean duration of operation was 260.1 ± 33.4 minutes (185–335 minutes). The mean intraoperative blood loss was 114.2 ± 191.4 ml (10–800 ml). In 51 (51%) of the patients, complications occurred in perioperative, early postoperative and late postoperative periods. In postoperative complications, anastomotic leak rate was eight patients (8%) and pulmonary complication rate was 21 patients (21%). While mortality was seen in three patients that had diabetes mellitus and hypertension, the 30-day mortality was 2% and the hospital mortality was 3%. The mean hospital stay was 11.2 ± 8.3 days (range 8–44). In our study, the probability of one-year overall survival was 91% and the probability of two years overall survival was 66%. Conclusion Minimally invasive esophagectomy is a safe and preferred method with low mortality, acceptable morbidity, short operative time and short hospital stay and has become a routine approach in the treatment of esophageal cancers. Multicenter studies to be performed in the near future will further assist in defining the benefits of minimally invasive esophagectomy. Disclosure All authors have declared no conflicts of interest.

The usefulness of three-dimensional video-assisted thoracoscopic esophagectomy in esophageal cancer patients

Esophagus ◽  
2019 ◽  
Vol 16 (3) ◽  
pp. 272-277 ◽  
Author(s):  
Kotaro Yamashita ◽  
Shinji Mine ◽  
Tasuku Toihata ◽  
Ian Fukudome ◽  
Akihiko Okamura ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Three Dimensional ◽  
Thoracoscopic Esophagectomy ◽  
Video Assisted

Different recurrence pattern after neoadjuvant chemoradiotherapy compared to surgery alone in esophageal cancer patients.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 82-82
Author(s):  
John Theodorus Plukker ◽  
Justin Smit ◽  
Sahin Guler ◽  
Jannet Beukema ◽  
Veronique E. Mul ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Cancer Patients ◽  
Neoadjuvant Chemoradiotherapy ◽  
Distant Recurrence ◽  
Rank Test ◽  
Skeletal Metastases ◽  
Recurrence Pattern ◽  
Common Site ◽  
Historical Cohort ◽  
Log Rank Test

82 Background: Neoadjuvant chemoradiotherapy (CRT) is currently considered standard treatment in esophageal cancer patients who are eligible for surgical resection with curative intent. Objective was to evaluate the recurrence pattern after neoadjuvant CRT in patients with esophageal cancer. Methods: We analyzed the results and recurrence patterns from a single center (N=152) in a propensity score matched study between patients treated with neoadjuvant CRT (N=44) and surgery alone (44 from the 108),in the period 2002-2010. Patients treated with neoadjuvant (CROSS schedule) carboplatin/paclitaxel and 41.4 Gy radiotherapy, were compared with a historical cohort of patients with curative intended surgery alone. Surgery was performed through a transthoracic approach with 2-field lymphadenectomy. Results: After matching, the baseline characteristics were equally distributed between both groups (table 1). The response to CRT was 63%, with a pathological complete response of 26%. After a median follow-up of 23 months (7-74 months), lung was the most common site of distant recurrence (16%, N=7), followed by distant lymph nodes (11%, N=5) in the neoadjuvant CRT group, whereas skeletal metastases were the most common site of distant recurrence (18%, N=8), followed by skin or soft tissue (16%, N=7) in the surgical alone group. The estimated 3 and 5 year overall survival was 62% and 55% in the neoadjuvant CRT group, compared to 37% and 31% in the surgery group (Log-rank test: P=0.018). The estimated locoregional free recurrence survival (LRFS) after 3 and 5 years was 79% and 68% in the neoadjuvant CRT group, compared to 44% and 40% in the surgery alone group (Log-rank test: P=0.049). The estimated distant recurrence free survival (DRFS) was 63% and 54% after 3 and 5 years in the neoadjuvant CRT group, compared to 50% and 35% in the surgery alone group (Log-rank test: P=0.314). Conclusions: This neoadjuvant CRT regimen significantly improved oncological outcome compared to surgery alone. An important shift in recurrence pattern was observed from relatively high locoregional recurrences (LRFS) to relatively more distant recurrences (DRFS) in the CRT group compared to the surgery alone group.

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