The prognostic impact of minimally invasive esophagectomy on survival after esophagectomy following a delayed interval after chemoradiotherapy; a secondary analysis of the DICE study
<p><strong>Objective: </strong></p> To evaluate prognostic differences between minimally invasive esophagectomy (MIE) and open esophagectomy (OE) in patients with surgery after a prolonged interval (>12 wk) following chemoradiotherapy (CRT). <p><strong> Bac...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Conference item |
| Language: | English |
| Published: |
Lippincott, Williams & Wilkins
2024
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| _version_ | 1826317306733527040 |
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| author | Markar, SR Sgromo, B Evans, R Griffiths, EA Alfieri, R Castoro, C Gronnier, C Gutschow, CA Piessen, G Capovilla, G Grimminger, PP Low, DE Gossage, J Gisbertz, SS Ruurda, J van Hillegersberg, R D'journo, XB Phillips, AW Rosati, R Hanna, GB Maynard, N Hofstetter, W Ferri, L Berge Henegouwen, MI Owen, R |
| author_facet | Markar, SR Sgromo, B Evans, R Griffiths, EA Alfieri, R Castoro, C Gronnier, C Gutschow, CA Piessen, G Capovilla, G Grimminger, PP Low, DE Gossage, J Gisbertz, SS Ruurda, J van Hillegersberg, R D'journo, XB Phillips, AW Rosati, R Hanna, GB Maynard, N Hofstetter, W Ferri, L Berge Henegouwen, MI Owen, R |
| author_sort | Markar, SR |
| collection | OXFORD |
| description | <p><strong>Objective: </strong></p>
To evaluate prognostic differences between minimally invasive esophagectomy (MIE) and open esophagectomy (OE) in patients with surgery after a prolonged interval (>12 wk) following chemoradiotherapy (CRT).
<p><strong>
Background: </strong></p>
Previously, we established that a prolonged interval after CRT prior to esophagectomy was associated with poorer long-term survival.<p><strong>
Methods: </strong></p>
This was an international multi-center cohort study involving seventeen tertiary centers, including patients who received CRT followed by surgery between 2010-2020. Patients undergoing MIE were defined as thoracoscopic and laparoscopic approach.
<p><strong>
Results: </strong></p>
428 patients (145 MIE and 283 OE) had surgery between 12 weeks and two years after CRT. Significant differences were observed in ASA grade, radiation dose, clinical T stage, and histological subtype. There were no significant differences between the groups in age, sex, BMI, pathological T or N stage, resection margin status, tumor location, surgical technique, or 90-day mortality. Survival analysis showed MIE was associated with improved survival in univariate (P=0.014), multivariate analysis after adjustment for smoking, T and N stage, and histology (HR=1.69; 95% CI 1.14 to 2.5) and propensity matched analysis (P=0.02). Further subgroup analyses by radiation dose and interval after CRT showed survival advantage for MIE, in 40-50Gy dose groups (HR=1.9; 95% CI 1.2 to 3.0), and in patients having surgery within six months of CRT (HR=1.6; 95% CI 1.1 to 2.2).
<p><strong>
Conclusion:</strong></p>
MIE was associated with an improved overall survival compared to OE in patients with a prolonged interval from CRT to surgery. The mechanism for this observed improvement in survival remains unknown, with potential hypotheses including a reduction in complications and improved functional recovery after MIE. |
| first_indexed | 2024-09-25T04:20:37Z |
| format | Conference item |
| id | oxford-uuid:784468c5-63ce-401c-8b92-1f0466e1367e |
| institution | University of Oxford |
| language | English |
| last_indexed | 2025-02-19T04:36:24Z |
| publishDate | 2024 |
| publisher | Lippincott, Williams & Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:784468c5-63ce-401c-8b92-1f0466e1367e2025-02-04T09:18:47ZThe prognostic impact of minimally invasive esophagectomy on survival after esophagectomy following a delayed interval after chemoradiotherapy; a secondary analysis of the DICE studyConference itemhttp://purl.org/coar/resource_type/c_5794uuid:784468c5-63ce-401c-8b92-1f0466e1367eEnglishSymplectic ElementsLippincott, Williams & Wilkins 2024Markar, SRSgromo, BEvans, RGriffiths, EAAlfieri, RCastoro, CGronnier, CGutschow, CAPiessen, GCapovilla, GGrimminger, PPLow, DEGossage, JGisbertz, SSRuurda, Jvan Hillegersberg, RD'journo, XBPhillips, AWRosati, RHanna, GBMaynard, NHofstetter, WFerri, LBerge Henegouwen, MIOwen, R<p><strong>Objective: </strong></p> To evaluate prognostic differences between minimally invasive esophagectomy (MIE) and open esophagectomy (OE) in patients with surgery after a prolonged interval (>12 wk) following chemoradiotherapy (CRT). <p><strong> Background: </strong></p> Previously, we established that a prolonged interval after CRT prior to esophagectomy was associated with poorer long-term survival.<p><strong> Methods: </strong></p> This was an international multi-center cohort study involving seventeen tertiary centers, including patients who received CRT followed by surgery between 2010-2020. Patients undergoing MIE were defined as thoracoscopic and laparoscopic approach. <p><strong> Results: </strong></p> 428 patients (145 MIE and 283 OE) had surgery between 12 weeks and two years after CRT. Significant differences were observed in ASA grade, radiation dose, clinical T stage, and histological subtype. There were no significant differences between the groups in age, sex, BMI, pathological T or N stage, resection margin status, tumor location, surgical technique, or 90-day mortality. Survival analysis showed MIE was associated with improved survival in univariate (P=0.014), multivariate analysis after adjustment for smoking, T and N stage, and histology (HR=1.69; 95% CI 1.14 to 2.5) and propensity matched analysis (P=0.02). Further subgroup analyses by radiation dose and interval after CRT showed survival advantage for MIE, in 40-50Gy dose groups (HR=1.9; 95% CI 1.2 to 3.0), and in patients having surgery within six months of CRT (HR=1.6; 95% CI 1.1 to 2.2). <p><strong> Conclusion:</strong></p> MIE was associated with an improved overall survival compared to OE in patients with a prolonged interval from CRT to surgery. The mechanism for this observed improvement in survival remains unknown, with potential hypotheses including a reduction in complications and improved functional recovery after MIE. |
| spellingShingle | Markar, SR Sgromo, B Evans, R Griffiths, EA Alfieri, R Castoro, C Gronnier, C Gutschow, CA Piessen, G Capovilla, G Grimminger, PP Low, DE Gossage, J Gisbertz, SS Ruurda, J van Hillegersberg, R D'journo, XB Phillips, AW Rosati, R Hanna, GB Maynard, N Hofstetter, W Ferri, L Berge Henegouwen, MI Owen, R The prognostic impact of minimally invasive esophagectomy on survival after esophagectomy following a delayed interval after chemoradiotherapy; a secondary analysis of the DICE study |
| title | The prognostic impact of minimally invasive esophagectomy on survival after esophagectomy following a delayed interval after chemoradiotherapy; a secondary analysis of the DICE study |
| title_full | The prognostic impact of minimally invasive esophagectomy on survival after esophagectomy following a delayed interval after chemoradiotherapy; a secondary analysis of the DICE study |
| title_fullStr | The prognostic impact of minimally invasive esophagectomy on survival after esophagectomy following a delayed interval after chemoradiotherapy; a secondary analysis of the DICE study |
| title_full_unstemmed | The prognostic impact of minimally invasive esophagectomy on survival after esophagectomy following a delayed interval after chemoradiotherapy; a secondary analysis of the DICE study |
| title_short | The prognostic impact of minimally invasive esophagectomy on survival after esophagectomy following a delayed interval after chemoradiotherapy; a secondary analysis of the DICE study |
| title_sort | prognostic impact of minimally invasive esophagectomy on survival after esophagectomy following a delayed interval after chemoradiotherapy a secondary analysis of the dice study |
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