Minimally Invasive Esophagectomy

Diseases of the Esophagus (2016) 29, 3A–162A DOI: 10.1111/dote.12528

ABSTRACT SUPPLEMENT

Date: September 19, 2016, 08:00 - 10:00 FA01: Featured Abstracts 1: Minimally Invasive Esophagectomy (Malignant) Room: Topaz Concourse FA01.01: SURVIVAL AFTER MINIMALLY INVASIVE VERSUS OPEN OESOPHAGECTOMY FOR PATIENTS WITH OESOPHAGEAL CANCER Jennifer Straatman1, Miguel Cuesta2, Josep Roig Garcia3, Luigi Bonavina4, C Rosman5, Suzanne Gisbertz6, D.L. Van Der Peet1 1 VU Medical Centre, Amsterdam/NETHERLANDS, 2VU University Medical Center, Amsterdam/NETHERLANDS, 3Hospital Unversitario de Josep Trueta, Girona/SPAIN, 4Gruppo San Donato, Milano/ITALY, 5Canisius Wilhelmina Ziekenhuis, Nijmegen/NETHERLANDS, 6Academisch Medisch Centrum, Amsterdam/NETHERLANDS Background: Research on Minimally Invasive Esophagectomy has shown faster postoperative recovery and has lead to a marked decrease in pulmonary complications. Debate is ongoing as to whether the procedure is safe with regard to long-term data. The aim of the TIME-trial (Traditional invasive vs. minimally invasive esophagectomy, a multi-center, randomized trial) was to compare 3-year survival and disease-free survival after minimally invasive and open resection of esophageal cancer. Methods: Between June 1, 2009, and March 31, 2011 Patients with a resectable intrathoracic esophageal carcinoma, including the gastro-esophageal junction tumors (Siewert I) were randomized between open and minimally invasive transthoracic esophagectomy with curative intent. Primary outcome is 3-year disease-free survival. Secondary outcomes include overall 3-year survival, short-term morbidity, mortality, pulmonary complications, radicality, local recurrence and metastasis. Analysis was by intention-to-treat. This trial is registered with the Netherlands Trial Register, NTR TC 2452. Results: One hundred fifteen patients were included from six European hospitals and randomly assigned to open transthoracic esophagectomy (n556) and minimally invasive transthoracic esophagectomy (n559). Combined overall median survival was 27 months (range 1 - 68 months). No differences were observed in radicality, number of retrieved lymph nodes and mortality. Combined 3-year survival was 40,4% (SD 7,7%) in the open group versus 50,5% (SD 8%) in the minimally invasive group (p50,207). The hazard ratio (HR) for disease free survival was 0,691 (0,389 – 1,239) for minimally invasive surgery compared to open surgery. The combined overall 3-year survival was 35,9% (SD 6,8%) in the open group versus 40,2% (SD6,9 %) in the minimally invasive group. The HR for overall survival was 0,883 (0,540 – 1,441) for minimally invasive surgery compared to open surgery. Discussion: The here presented study depicted no differences in disease free and overall 3-year survival for open and minimally invasive transthoracic esophagectomy. These results, together with short term results depicting less pulmonary complications and similar radicality and lymph node retrieval, further support the use of minimally invasive surgical techniques in the treatment of intrathoracic esophageal cancer and Siewert II junction tumors. Disclosure: All authors have declared no conflicts of interest. Keywords: Esophageal cancer, minimally invasive surgery, Survival FA01.02: COMPARISON OF MINIMALLY INVASIVE ESOPHAGECTOMY WITH OPEN ESOPHAGECTOMY: NATIONWIDE STUDY IN JAPAN Hiroya Takeuchi1, Hiroaki Miyata1, Hirofumi Kawakubo1, Soji Ozawa2, Harushi Udagawa3, Harushi Osugi4, Hisahiro Matsubara5, Yuko Kitagawa1 1 Keio University School of medicine, Tokyo/JAPAN, 2Tokai University School of Medicine, Kanagawa/JAPAN, 3Toranomon Hospital, Tokyo/JAPAN, 4 Graduate School of Medicine, Osaka City University, Osaka/JAPAN, 5 Graduate School of Medicine, Chiba University, Chiba/JAPAN Background: In this study, we focused on the comparison of minimally invasive esophagectomy (MIE) such as thoracoscopic esophagectomy and open esophagectomy (OE) objectively by propensity score matching using a Japanese nationwide database. Methods: The National Clinical Database (NCD) which commenced in 2011, is a nationwide project that is linked to the surgical board certification system in Japan. Propensity score matching was performed to compare the MIE with the OE by use of the 2011-2012 NCD database. Results: Esophagectomy for 9584 patients with thoracic esophageal cancer were categorized into MIE (n 5 3589) with OE (n 5 5995) in the NCD 20112012 database. Preoperative background factors of the patients compared were quite different between the two groups. In general, OE was preferred to be chosen for patients with worse overall health condition. Propensity score

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matching created a matched cohort of 3515 pairs of patients. The operative time was significantly longer in the MIE group than in the OE group, whereas blood loss was markedly lesser in the MIE group than in the OE group. There was no significant differences in overall morbidity between the two groups. The incidence of the patients who needed prolonged respiratory ventilation more than 48 hours after surgery was significantly less in the MIE group than the OE group (P 5 0.006). However, the incidence of postoperative recurrence laryngeal nerve palsy was significantly more in the MIE group than in the OE group (10.3% vs. 8.1%, P 5 0.002). Moreover, the incidence of gastric conduit necrosis also tended to be higher in the MIE group compared with the OE group (0.8% vs. 0.4%, P 5 0.087). The reoperation rate within 30 days was significantly higher in the MIE group than in the OE group (7.0% vs 5.3%, P 5 0.004). There were no significant differences in 30-day or operative mortality rates between the MIE and OE groups. Discussion: Our results suggest that MIE is comparable with conventional OE in terms of short-term outcomes after surgery. Based on this study, we started a randomized controlled trial, JCOG1409, which compare the short- and long-term outcomes between the two procedures in Japan. Disclosure: All authors have declared no conflicts of interest. Keywords: Minimally Invasive Esophagectomy, Esophageal cancer, Thoracoscopic esophagectomy FA01.03: IMPACT OF MINIMALLY INVASIVE SURGERY AND GASTRIC TUBE ON THE QUALITY OF LIFE IN PATIENTS WITH ESOPHAGEAL CANCER Ming Du The First Affiliated Hospital of Chongqing Medical University, Chongqing/ CHINA Background: In the treatment of malignant tumors, the patients quality of life (QOL) has gained increasing attention. In this study, postoperative clinical indicators of the patients with esophageal cancer were collected in the form of questionnaire surveys in order to explore the influencing factors of the postoperative QOL. Methods: From September 2007 to May 2011, a total of 224 patients with esophageal cancer underwent esophageal resection in our hospital were divided into four groups according to the surgical approaches, including: group A (52 cases of open surgery1gastric tube), group B (52 cases of open surgery1whole stomach), group C (60 cases of minimally invasive surgery1gastric tube), and group D (60 cases of minimally invasive surgery1total gastrectomy group). The questionnaire was developed according to the QLQ-C30 questionnaire and esophageal cancer-specific questionnaire (QLQ-OES24), which was administrated during the follow-up in the 3rd week, 6th month, and 12th month after the surgery in order to evaluate the QOL. Results: The operation time and blood loss were less in groups C and D as compared to those of the group A and B (p