title: Hybrid minimally invasive Ivor Lewis esophagectomy after neoadjuvant chemoradiation yields excellent long-term survival outcomes with minimal morbidity.
abstract: BACKGROUND
  There is a clear survival benefit to neoadjuvant chemoradiation prior to esophagectomy for patients with stages II-III esophageal cancer. A minimally invasive esophagectomy approach may decrease morbidity but is more challenging in a previously radiated field and therefore patients who undergo neoadjuvant chemoradiation may experience more postoperative complications.
  
  
  METHODS
  A prospective database of all esophageal cancer patients who underwent attempted hybrid minimally invasive Ivor Lewis esophagectomy was maintained between 2006 and 2015. The clinical characteristics, neoadjuvant treatments, perioperative complications, and survival outcomes were reviewed.
  
  
  RESULTS
  Overall 30- and 90-day mortality rates were 0.8% (1/131) and 2.3% (3/131), respectively. The majority of patients 58% (76/131) underwent induction treatment without significant adverse impact on mortality, major complications, or hospital stay. Overall survival at 1, 3, and 5 years was 85.9%, 65.3%, and 53.9%. Five-year survival by pathologic stage was stage I 68.9%, stage II 54.0%, and stage III 29.6%.
  
  
  CONCLUSIONS
  The hybrid minimally invasive Ivor Lewis esophagectomy approach results in low perioperative morbidity and mortality and is well tolerated after neoadjuvant chemoradiation. Good long-term overall survival rates likely resulted from combined concurrent neoadjuvant chemoradiation in the majority of patients, which did not impact the ability to safely perform the operation or postoperative complications rates. J. Surg. Oncol. 2016;114:838-847. © 2016 2016 Wiley Periodicals, Inc.
authors: Department of Surgery, University of California San Francisco, San Francisco, California.
authors: Gavitt A
authors: GA
authors: Woodard
authors: Department of Surgery, University of California San Francisco, San Francisco, California.
authors: Jane C
authors: JC
authors: Crockard
authors: Department of Surgery, University of California San Francisco, San Francisco, California.
authors: Carolyn
authors: C
authors: Clary-Macy
authors: Department of Surgery, University of California San Francisco, San Francisco, California.
authors: Clara T
authors: CT
authors: Zoon-Besselink
authors: Department of Pathology, University of California San Francisco, San Francisco, California.
authors: Kirk
authors: K
authors: Jones
authors: Division of Hematology and Oncology, University of California San Francisco, San Francisco, California.
authors: Wolfgang Michael
authors: WM
authors: Korn
authors: Division of Hematology and Oncology, University of California San Francisco, San Francisco, California.
authors: Andrew H
authors: AH
authors: Ko
authors: Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
authors: Alexander R
authors: AR
authors: Gottschalk
authors: Department of Surgery, University of California San Francisco, San Francisco, California.
authors: Stanley J
authors: SJ
authors: Rogers
authors: Department of Surgery, University of California San Francisco, San Francisco, California. david.jablons@ucsf.edu.
authors: David M
authors: DM
authors: Jablons
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D059186:Chemoradiotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D018358:Neuroendocrine Tumors / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016019:Survival Analysis; D013908:Thoracotomy; D016896:Treatment Outcome
keywords: complete pathologic response; esophageal cancer long-term survival; esophagectomy complications; esophagectomy mortality; neoadjuvant chemoradiation