Introduction The aim of this study was to ascertain recurrence and survival following Ivor-Lewis oesophagectomy for oesophageal cancer at our hospital.
Method Ivor-Lewis oesophagectomy resections performed by three consultant surgeons from 2007 to present at an English university hospital were recorded on a prospectively maintained database. The Somerset Cancer database and our hospitals own electronic record system (Integrated Clinical Environment) were used to retrieve data on treatment protocols, tumour histology, staging and survival.
Results Between March 2007 and February 2014 159 patients underwent oesophagectomy at the Royal Sussex County Hospital, Brighton, UK. M:F 130:29. Average age at surgery was 64 years. Pre-operative histology identified 87% adenocarcinomas, 11% squamous cell carcinoma and 2% high grade dysplasia. Barrett’s was identified on histology in 49% of patients with adenocarcinoma. Neo-adjuvant chemotherapy (predominantly ECX) was received by 84% of the cohort however 11% of these cases did not complete treatment due to complications. Of those receiving neo-adjuvant chemotherapy 16% had stable disease based on final staging, 53% achieved down staging and 31% had progressive disease. Final staging (using TNM 7thEdition) found: 9% stage 0, 23% stage I, 29% stage II, 24% stage III and 15% stage IV. R0 resection was achieved in 59% of cases. A >5 cm distal resection margin was achieved in 57% of cases compared to only 24% of proximal resection margins. Adjuvant chemotherapy was received in only 13% of cases. Recurrence occurred in 37% of cases and the average time to recurrence was 494 days. Of the R1 resections 45% had recurrence compared to 32% of R0 cases. For this cohort 1 year survival was 79.2%, 2 year survival was 64.2% and 3 year survival was 45%. Laparoscopic gastric mobilisation (LGM) was practiced by one of three surgeons from July 2010 and accounted for 36% of cases over this time period. Average lymph node (LN) harvest in LGM cases was 19.6 and 13 for totally open (TO) cases over the same time period. The recurrence rate was higher in TO compared to LGM (RR = 1.7) despite a greater proportion of higher stage cancers in the LGM group (stage III and IV 56% vs 29%) however there was no statistically significant difference in mortality between the two groups.
Conclusion Despite achieving R0 resection on final histology nearly a third of these patients experienced recurrence suggesting the need for more aggressive adjuvant therapy. Neo-adjuvant down staging in 53% of cases is comparable to previous published data.1Despite a greater LN harvest and reduced recurrence rate observed in the LGM group this did not impact on overall survival.
Disclosure of interest None Declared.
Bamias. Cancer 1996;77:1978–1985