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

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.

Outcomes after chemoradiation alone for adenocarcinoma of the esophagus and gastroesophageal junction.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 138-138
Author(s):  
Anthony Pham ◽  
Karyn A. Goodman ◽  
David H. Ilson ◽  
Yelena Yuriy Janjigian ◽  
Geoffrey Yuyat Ku ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Gastroesophageal Junction ◽  
Complete Response ◽  
Local Failure ◽  
Term Survival ◽  
Trimodality Therapy ◽  
Free Survival ◽  
Kaplan Meier ◽  
Immediate Surgery

138 Background: Definitive chemoradiation (CRT) is a standard treatment for esophageal cancer (EC), particularly squamous cell carcinoma (SCC). However, data for nonsurgical treatment of adenocarcinoma (AC) is limited, and response rates to CRT are lower in AC vs. SCC. Therefore, trimodality therapy is often preferred for AC. However, some patients with AC achieve clinical complete response (cCR) after CRT and decline surgery, or are medically inoperable. We therefore reviewed outcomes after CRT alone for esophageal AC. Methods: All patients receiving full-dose (≥ 50 Gy) CRT without surgery for Stage I-III AC of the esophagus or gastroesophageal junction (GEJ) from 2007-2012 at our institution were included. Complete clinical response (cCR) was defined as negative post-CRT biopsy, or SUVmax ≤ 3 on post-CRT PET if no biopsy was obtained. Local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Results: 105 patients were included. 11 patients (10%) had T1-2N0 disease; the rest had T3+ or N+ disease. Median follow-up was 49 months. 85 patients (81%) received induction chemotherapy prior to CRT. Median OS was 25 months, with 3/5 year OS of 35% and 20% respectively. 67 patients (64%) had cCR, with median OS of 33 months and 3/5 year OS of 48% and 30%, compared to 15 months in incomplete responders (p<0.001). There were no long-term survivors among incomplete responders. 31 (46%) of cCR patients developed local failure, with 3 and 5 year LRFS of 53% and 46%. Median DMFS was 33 months in cCR patients. Of 10 patients who developed isolated local failure, 6 had salvage surgery, 3 had brachytherapy and 1 had laser ablation. Of these, 3 are alive and 2 are free of disease. Conclusions: This is the largest reported series of CRT alone for esophageal AC. In cCR patients, CRT alone is associated with long-term survival comparable to that expected with trimodality therapy. However, local recurrence still occurs in nearly half of patients with cCR. More study is needed to define which patients with cCR will benefit from immediate surgery after CRT, and improvements in therapy are needed to reduce local failure in patients not eligible for surgery.

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

2016 ◽  
Vol 114 (7) ◽  
pp. 838-847 ◽  
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

scholarly journals Cryoablation of renal tumors: long-term follow-up from a multicenter experience

2021 ◽  
Author(s):  
Fulvio Stacul ◽  
Camilla Sachs ◽  
Fabiola Giudici ◽  
Michele Bertolotto ◽  
Michele Rizzo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tumor Size ◽  
Treatment Efficacy ◽  
Survival Rates ◽  
Oncologic Outcomes ◽  
Renal Tumors ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Overall Survival Rates

Abstract Purpose To retrospectively investigate long-term outcomes of renal cryoablation from a multicenter database. Methods 338 patients with 363 renal tumors underwent cryoablation in 4 centers in North-Eastern Italy. 340/363 tumors (93.7%) were percutaneously treated with CT guidance. 234 (68.8%) were treated after conscious sedation, 76 (22.3%) under local lidocaine anesthesia only and 30 (8.8%) under general anesthesia. Treatment efficacy and complication rate considered all procedures. Oncologic outcomes considered a subset of 159 patients with 159 biopsy proven renal cell carcinoma. Results Mean tumor size was 2.53 cm. Technical success was achieved in 355/363 (97.8%) treatments. Treatment efficacy after the first treatment was achieved in 348/363 (95.9%) tumors. Statistical analysis revealed a significant lower treatment efficacy for ASA score >3, Padua score >8, tumor size >2.5 cm, use of >2 cryoprobes, presence of one single kidney. In the subset of 159 patients, recurrence-free survival rates were 90.5% (95% CI 83.0%, 94.9%) at 3 years and 82.4% (95% CI 72.0%, 89.4%) at 5 years; overall survival rates were 96.0% (95% CI 90.6%, 98.3%) at 3 years and 91.0% (95% CI 81.7%, 95.7%) at 5 years; no patient in this subset developed metastatic disease. Clavien-Dindo >1 complications were recorded in 14/369 procedures (3.8%) and were related to age >70 years, tumor size >4 cm and use of >2 cryoprobes. Conclusion Cryoablation performed across four different centers in a large cohort of predominantly small renal tumors showed that this technique provides good recurrence-free survival rates and overall survival rates at three- and five-year with very low major complications rate.

Relationship between perioperative change of total psoas muscle area and cancer prognosis in esophageal carcinoma.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 314-314
Author(s):  
Kazuaki Matsui ◽  
Hirofumi Kawakubo ◽  
Satoru Matsuda ◽  
Shuhei Mayanagi ◽  
Tomoyuki Irino ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Esophageal Carcinoma ◽  
Poor Prognosis ◽  
Univariate Analysis ◽  
Psoas Muscle ◽  
Recurrence Free Survival ◽  
Muscle Area ◽  
Free Survival ◽  
Long Term Prognosis

314 Background: As surgery for esophageal carcinoma in the elderly people has been increasing, sarcopenia is a severe problem not only in complications, but also in long-term prognosis. However, the relationship between perioperative skeletal muscle loss especially in the early postoperative period and long-term prognosis has not been clarified. Methods: This study retrospectively analyzed 152 patients with thoracic esophageal carcinoma who had underwent radical esophagectomy in our institution from April 2008 to March 2015 (Patients with postoperative hospital stay longer than 6 weeks were excluded). As an index of perioperative sarcopenia, total psoas muscle area (TPA) was measured before surgery (as baseline), at postoperative day (POD) 7 and postoperative month (POM) 6 from CT images. We investigated the correlation between the change of TPA and the postoperative survival. Results: Of 152 patients, 52 (34.2%) showed a TPA decrease from baseline to POD 7, and 98 (64.5%) showed a TPA decrease from baseline to POM 6. At the time of POD 7, overall survival (OS) decreased significantly in a TPA decrease group (P = 0.008, 5-year survival rate: non-decrease group 82.3% / decrease group 56.8%). Recurrence free survival (RFS) was also significantly decreased in a TPA decrease group (P < 0.001, 5-year recurrence free survival rate: non-decrease group 73.7% / decrease group 44.9%). On the other hand, at the time of POM 6, OS and also RFS had no significant difference between decrease and non-decrease groups. In univariate analysis for OS, pStage ≥3 and TPA decrease at POD 7 had poor prognosis. In multivariate analysis for OS, pStage ≥3 (HR:5.516, P < 0.001, 95%CI:2.634-11.551) and TPA decrease at POD 7 (HR:2.036, P = 0.047, 95%CI:1.010-4.103) were also independent poor prognostic factors. In the univariate analysis for RFS, pStage ≥3, TPA decrease at POD 7 and age ≥60 years had poor prognosis. In multivariate analysis, pStaeg ≥3 (HR:3.831, P < 0.001, 95%CI:2.182-6.728) and TPA decrease at POD 7 (HR:1.942, P = 0.021, 95%CI:1.104-3.416) were independent poor prognostic factors. Conclusions: Our findings suggest that the TPA decrease early in a postoperative period has poor prognosis on OS and also RFS.

Long-term outcomes after robotic-assisted Ivor Lewis esophagectomy

2021 ◽  
Author(s):  
Pridvi Kandagatla ◽  
Ali Hussein Ghandour ◽  
Ali Amro ◽  
Andrew Popoff ◽  
Zane Hammoud
Keyword(s):  
Long Term Outcomes ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Ivor Lewis Esophagectomy

scholarly journals Long-term recurrence-free survival in a patient with stage IVB uterine carcinosarcoma

2011 ◽  
Vol 22 (4) ◽  
pp. 292 ◽  
Author(s):  
Gun Yoon ◽  
Yong-Seok Kim ◽  
Byoung-Gie Kim ◽  
Duk-Soo Bae ◽  
Jeong-Won Lee
Keyword(s):  
Recurrence Free Survival ◽  
Uterine Carcinosarcoma ◽  
Free Survival ◽  
Stage Ivb

scholarly journals Impact of postoperative complications on long-term survival of hepatocellular carcinoma patients after liver resection

2021 ◽  
Author(s):  
Susumu Mochizuki ◽  
Hisashi Nakayama ◽  
Yutaka Midorikawa ◽  
Tokio Higaki ◽  
Masamichi Moriguchi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Liver Resection ◽  
Pleural Effusion ◽  
Postoperative Complications ◽  
Recurrence Free Survival ◽  
Term Survival ◽  
Free Survival ◽  
Long Term Survival

Objective The effect of postoperative complications including red blood transfusion (BT) on long-term survival for hepatocellular carcinoma (HCC) is unknown. The purpose of this study was to define the relationship between postoperative complications and long-term survival in patients with HCC. Methods Postoperative complications of 1251 patients who underwent curative liver resection for HCC were classified, and their recurrence-free survival (RFS) and cumulative overall survival (OS) were investigated. Results Any complications occurred in 503 patients (40%). Five-year RFS and 5-year OS in the complication group were 21% and 56%, respectively, significantly lower than the respective values of 32% ( p &lt; 0.001) and 68% ( p &lt; 0.001) in the no-complication group (n=748). Complications related to RFS were postoperative BT [Hazard ratio (HR): 1.726, 95% confidence interval (CI): 1.338–2.228, p &lt; 0.001], pleural effusion [HR: 1.434, 95% CI: 1.200–1.713, p &lt; 0.001] using Cox-proportional hazard model. Complications related to OS were postoperative BT [HR: 1.843, 95%CI: 1.380-2.462, p &lt; 0.001], ascites [HR: 1.562, 95% CI: 1.066–2.290 p = 0.022], and pleural effusion [HR: 1.421, 95% CI: 1.150–1.755, p = 0.001). Conclusions Postoperative complications were factors associated with poor long-term survival. Postoperative BT and pleural effusion, were noticeable complications that were prognostic factors for both recurrence-free survival and overall survival.

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