Anastomotic Complications After Ivor Lewis Esophagectomy in Patients Treated With Neoadjuvant Chemoradiation Are Related to Radiation Dose to the Gastric Fundus

Abstract Anastomotic leak (AL) and conduit necrosis (CN) are among the most serious surgical complications after esophageal resection. Endoscopic, radiological and surgical methods are used in their treatment. The aim of this paper is to evaluate the results of the treatment of acute anastomotic complications after Ivor-Lewis esophagectomy in a single high-volume center. Methods We performed a retrospective audit of a consecutive cohort of 815 patients undergoing transthoracic esophagectomy with intrathoracic esophago-gastric anastomosis from 2005 to 2019. AL was graded according to Esophagectomy Complications Consensus Group recommendation. Results There were 79 patients with AL and 6 patients with CN (10%). AL type I, II and III was diagnosed in 33 (39%), 25 (29%) and 27 (32%) patients, respectively. Esophageal stent was used in 40 patients. Primary surgical revision (with/without stent insertion) was performed in 14 patients. Reoperation was necessary overall in 25 patients (29%). Seventeen patients (20%) ended-up with esophageal diversion. Treatment with esophageal stent was successful in 28/40 patients (70%). Endoscopic vacuum-therapy was successfully used in three patients for peristent leak after stent extraction. Mortality of severe AL (type II and III) was 10/52 patients (19%). Conclusion Successful management of acute anastomotic complications requires early diagnosis and an individual treatment approach with the use of endoscopic, radiological and surgical methods. The primary attempt for anastomosis preservation using esophageal stent is desirable. Considering the clinical condition and CT finding, we recommend not to hesitate with surgical revision with debridement and drainage of pleural cavity and mediastinum. If primary therapy fails, life-saving procedure is the esophageal diversion.

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Radiation dose does not influence anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation and transhiatal esophagectomy

Radiation Oncology ◽

10.1186/s13014-015-0361-4 ◽

2015 ◽

Vol 10 (1) ◽

pp. 59 ◽

Cited By ~ 10

Author(s):

Marijn Koëter ◽

Maurice van der Sangen ◽

Coen W Hurkmans ◽

Misha Luyer ◽

Harm Rutten ◽

...

Keyword(s):

Esophageal Cancer ◽

Radiation Dose ◽

Neoadjuvant Chemoradiation ◽

Transhiatal Esophagectomy ◽

Anastomotic Complications

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Short-term outcome of Ivor Lewis esophagectomy following neoadjuvant chemoradiation versus perioperative chemotherapy in patients with locally advanced adenocarcinoma of the esophagus and gastroesophageal junction: a propensity score-matched analysis

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-021-03720-5 ◽

2021 ◽

Author(s):

Patrick Sven Plum ◽

Alexander Damanakis ◽

Lisa Buschmann ◽

Angela Ernst ◽

Rabi Raj Datta ◽

...

Keyword(s):

Propensity Score ◽

Postoperative Morbidity ◽

Locally Advanced ◽

Neoadjuvant Chemoradiation ◽

Perioperative Chemotherapy ◽

Charlson Score ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Gastroesophageal Adenocarcinoma ◽

Matching Criteria

Abstract Background Patients with locally advanced esophageal or gastroesophageal adenocarcinoma benefit from multimodal therapy concepts including neoadjuvant chemoradiation (nCRT), respectively, perioperative chemotherapy (pCT). However, it remains unclear which treatment is superior concerning postoperative morbidity. Methods In this study, we compared the postsurgical survival (30-day/90-day/1-year mortality) (primary endpoint), treatment response, and surgical complications (secondary endpoints) of patients who either received nCRT (CROSS protocol) or pCT (FLOT protocol) due to esophageal/gastroesophageal adenocarcinoma. Between January 2013 and December 2017, 873 patients underwent Ivor Lewis esophagectomy in our high-volume center. 339 patients received nCRT and 97 underwent pCT. After 1:1 propensity score matching (matching criteria: sex, age, BMI, ASA score, and Charlson score), 97 patients per subgroup were included for analysis. Results After matching, tumor response (ypT/ypN) did not differ significantly between nCRT and pCT (p = 0.118, respectively, p = 0.174). Residual nodal metastasis occurred more often after pCT (p = 0.001). Postsurgical mortality was comparable within both groups. No patient died within 30 or 90 days after surgery while the 1-year survival rate was 72.2% for nCRT and 68.0% for pCT (p = 0.47). Only grade 3a complications according to Clavien–Dindo were increased after pCT (p = 0.04). There was a trend towards a higher rate of pylorospasm within the pCT group (nCRT: 23.7% versus pCT: 37.1%) (p = 0.061). Multivariate analysis identified pCT, younger age, and Charlson score as independent variables for pylorospasm. Conclusion Both nCRT and pCT are safe and efficient within the multimodal treatment of esophageal/gastroesophageal adenocarcinoma. We did not observe differences in postoperative morbidity. However, functional aspects such as gastric emptying might be more frequent after pCT.

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

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01728-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Robert E. Merritt ◽

Peter J. Kneuertz ◽

Mahmoud Abdel-Rasoul ◽

Desmond M. D’Souza ◽

Kyle A. Perry

Keyword(s):

Esophageal Carcinoma ◽

Complete Response ◽

Neoadjuvant Chemoradiation ◽

Oncologic Outcomes ◽

Recurrence Free Survival ◽

Trimodality Therapy ◽

Ivor Lewis ◽

Free Survival ◽

Ivor Lewis Esophagectomy

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.

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An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

Journal of Visualized Experiments ◽

10.3791/59255 ◽

2020 ◽

Author(s):

Neal K. Ramchandani ◽

Kenneth A. Kesler ◽

Jonathon D. Rogers ◽

Nakul Valsangkar ◽

Samatha M. Stokes ◽

...

Keyword(s):

Ivor Lewis ◽

Anastomotic Complications ◽

Ivor Lewis Esophagectomy ◽

Conduit Function

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Hybrid minimally invasive Ivor Lewis esophagectomy after neoadjuvant chemoradiation yields excellent long-term survival outcomes with minimal morbidity

Journal of Surgical Oncology ◽

10.1002/jso.24409 ◽

2016 ◽

Vol 114 (7) ◽

pp. 838-847 ◽

Cited By ~ 4

Author(s):

Gavitt A. Woodard ◽

Jane C. Crockard ◽

Carolyn Clary-Macy ◽

Clara T. Zoon-Besselink ◽

Kirk Jones ◽

...

Keyword(s):

Minimally Invasive ◽

Neoadjuvant Chemoradiation ◽

Survival Outcomes ◽

Term Survival ◽

Ivor Lewis ◽

Long Term Survival ◽

Minimal Morbidity ◽

Ivor Lewis Esophagectomy

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Robotic-assisted Ivor Lewis esophagectomy with or without neoadjuvant chemoradiation therapy for esophageal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.117 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 117-117

Author(s):

Franz Omar Smith ◽

Sarah Hoffe ◽

Khaldoun Almhanna ◽

Ravi Shridhar ◽

Richard C. Karl ◽

...

Keyword(s):

Esophageal Cancer ◽

Neoadjuvant Chemoradiation ◽

Chemoradiation Therapy ◽

Gastric Conduit ◽

Anastomotic Leaks ◽

Short Term ◽

Ivor Lewis ◽

Robotic Assisted ◽

Ivor Lewis Esophagectomy ◽

The Mean

117 Background: Neoadjuvant chemoradiation therapy (NT) has become standard of care for patients with locally advanced esophageal cancer. In selected patients, robotic-assisted Ivor Lewis esophagectomy (RAIL) is a safe and feasible operative strategy in the management of esophageal cancer. This study was designed to determine potential differences in peri-operative morbidity and short term outcomes in patients with esophageal cancer treated with RAIL with or without NT. Methods: A retrospective review of consecutive patients with esophageal cancer who underwent RAIL esophagectomy between October 2010 and June 2012 with and without NT was performed. Clinical and pathological variables were analyzed with two-sided student t-test assuming equal variance. Data were considered significant at a p-value <0.05. Results: Eighty-nine patients underwent RAIL during the study period. Seventy-seven patients (87%) received NT and twenty-two patients did not (13%). The median age was 66 years (range 44 – 84) and the median BMI was 28 kg/m2(range 16.7 – 40.1). All patients had a R0 resection. There were no differences in the mean estimated blood loss (149 vs.153 mL; p = 0.52) and mean operative times (434 vs. 427 minutes; p = 1.0). There were no differences in the incidence of pneumonia or atrial fibrillation, lengths of stay in the ICU, or length of hospitalization. In total, there were two anastomotic leaks and one leak from the gastric conduit. The anastomotic leaks occurred in the group that did not receive NT and the gastric conduit leak occurred in the group that received NT. There were no mortalities in either group. There was no difference in the mean number of lymph nodes harvested in the NT group (22 ± 11 vs. 20 ± 8, p = 0.41). Conclusions: RAIL can be safely performed following neoadjuvant chemoradiation therapy.In this series there were similar perioperative, morbidity and short-term mortality outcomes in patients who received NT compared with RAIL alone. Longer follow-up is required in order to determine long term oncologic outcome.

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