title: Minimally invasive esophagectomy is safe and effective following neoadjuvant chemoradiation therapy.
abstract: BACKGROUND
  Minimally invasive esophagectomy (MIE) is technically demanding, and implementation has been hindered by a steep learning curve. Despite widespread concern about the successful performance of this procedure following neoadjuvant chemoradiotherapy (NACR) treatment, we hypothesized that safe and effective MIE could be performed in this setting.
  
  
  METHODS
  We reviewed our prospective database of patients undergoing MIE for esophageal cancer at our institution between January 2008 and February 2010. We analyzed the association of NACR on perioperative outcomes and compared them with those patients undergoing MIE without NACR. NACR was used in ≥T2 or N+ tumors.
  
  
  RESULTS
  A total of 61 consecutive patients underwent a planned MIE. A complete MIE or hybrid procedure was performed in 58 patients (95%), while 3 patients were unresectable. Median age was 67 years (range 38-85). Anastomoses were performed in the cervical region in 47 patients (81%) while 11 patients had an anastomosis in the right chest. Serious complications included: 3 cervical anastomotic leaks (5%), 2 thoracic duct leaks (4%), 12 pneumonias (21%), 10 atrial fibrillations (18%), and 1 death in a patient not undergoing NACR. NACR was used in 41 patients. There was no significant difference in estimated blood loss (EBL), complications, or negative pathologic margins in patients undergoing NACR with MIE vs. MIE alone (P=NS). Median number of lymph nodes excised and PostOp LOS was 15 and 11 in patients undergoing NACR compared with 13 and 9 in those undergoing MIE alone (P=NS).
  
  
  CONCLUSIONS
  MIE is safe following NACR. Excellent results can be achieved with this operation in patients with advanced tumors.
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
authors.forename: Kfir
authors.initials: K
authors.lastname: Ben-David
authors.forename: George
authors.initials: G
authors.lastname: Rossidis
authors.forename: Robert A
authors.initials: RA
authors.lastname: Zlotecki
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Grobmyer
authors.forename: Juan C
authors.initials: JC
authors.lastname: Cendan
authors.forename: George A
authors.initials: GA
authors.lastname: Sarosi
authors.forename: Steven N
authors.initials: SN
authors.lastname: Hochwald
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate
chemical_list: D002945:Cisplatin; D005472:Fluorouracil