Safety of thoracoscopic esophagectomy after induction chemotherapy for locally advanced unresectable esophageal squamous cell carcinoma

Yuji Akiyama, Takeshi Iwaya, Fumitaka Endo, Haruka Nikai, Shigeaki Baba, Takehiro Chiba, Toshimoto Kimura, Takeshi Takahara, Koki Otsuka, Hiroyuki Nitta, Masaru Mizuno, Yusuke Kimura, Keisuke Koeda, Akira Sasaki

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

INTRODUCTION: Recent studies have reported that induction chemotherapy with docetaxel plus cisplatin and 5-fluorouracil (DCF) is an effective treatment for unresectable, locally advanced esophageal cancer. The aim of this study was to investigate the safety and feasibility of thoracoscopic esophagectomy (TE) after DCF for initially unresectable esophageal squamous cell carcinoma (ESCC). METHODS: Twenty-three patients with initially unresectable T4 thoracic ESCC underwent TE after induction DCF. RESULTS: The neighboring organs with tumors were the tracheobronchus in nine patients, thoracic aorta in 13, and pericardium and diaphragm in three each (concurrent overlapping invasion occurred in five patients). The mean total operation time was 556.3 ± 107.2 minutes, and the mean time of the thoracic procedure was 258.9 ± 83.9 minutes. The mean total blood loss was 166.2 ± 117.8 mL, and the loss during the thoracic procedure was 33.5 ± 24.6 mL. All patients achieved complete R0 resection under TE. No conversions to open thoracotomy were performed. The postoperative morbidity rate was 34.8%. The postoperative hospital stay was 24.3 (range, 13-38) days. Five patients had recurrence: four had distant metastasis (lung, two; liver, three; and one with overlap), and one had mediastinal lymph node recurrence. No local recurrence was noted at the site of the primary T4 tumor. CONCLUSIONS: TE was safely performed in 23 patients after DCF therapy for locally advanced unresectable ESCC. Induction DCF, followed by TE, could be an alternative treatment for unresectable T4 ESCC.

Original languageEnglish
Pages (from-to)152-159
Number of pages8
JournalAsian journal of endoscopic surgery
Volume13
Issue number2
DOIs
Publication statusPublished - 01-04-2020
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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