Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy

Background Patients  with esophageal cancer  that invades adjacent structures (cT4b) are precluded from surgery and usually treated with definitive chemoradiotherapy (dCRT). dCRT might result in sufficient downstaging to enable a radical resection, possibly improving survival. This study aimed to as...

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Veröffentlicht in:Annals of surgical oncology 2021-05, Vol.28 (5), p.2730-2738
Hauptverfasser: Defize, I. L., van der Horst, S., Bülbul, M., Haj Mohammad, N., Mook, S., Meijer, G. J., Brosens, L. A. A., Ruurda, J. P., van Hillegersberg, R.
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container_end_page 2738
container_issue 5
container_start_page 2730
container_title Annals of surgical oncology
container_volume 28
creator Defize, I. L.
van der Horst, S.
Bülbul, M.
Haj Mohammad, N.
Mook, S.
Meijer, G. J.
Brosens, L. A. A.
Ruurda, J. P.
van Hillegersberg, R.
description Background Patients  with esophageal cancer  that invades adjacent structures (cT4b) are precluded from surgery and usually treated with definitive chemoradiotherapy (dCRT). dCRT might result in sufficient downstaging to enable a radical resection, possibly improving survival. This study aimed to assess the perioperative and oncologic outcomes of a salvage robot-assisted minimally invasive esophagectomy (RAMIE) in patients with cT4b esophageal cancer after dCRT. Methods Between June 2012 and November 2019, patients who underwent a RAMIE with a gastric conduit reconstruction after completion of dCRT for cT4b esophageal carcinoma were identified from a prospectively maintained surgical database at the University Medical Center Utrecht. Results In total, 24 patients with a histopathologically confirmed T4b adenocarcinoma or squamous cell carcinoma of the esophagus were included. The adjacent organs involved were the tracheobronchial tree (67%), aorta (21%) or both (13%). No conversions or major intraoperative complications were observed. A radical resection was achieved in 22 patients (92%), and a pathologic complete response was observed in 13 (54%) patients. Postoperative grade 2 or higher complications occurred in 20 patients (83%). The disease-free survival at 24 months was 68% for the patients in whom a radical resection was achieved. Conclusion In patients with cT4b esophageal cancer treated with dCRT followed by a salvage RAMIE, a radical resection rate of 92% was achieved, with acceptable complications and promising survival rates. These results demonstrate the feasibility of a curative surgical treatment for patients with initially irresectable esophageal cancer but underscore the importance of a proper preoperative patient selection.
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L. ; van der Horst, S. ; Bülbul, M. ; Haj Mohammad, N. ; Mook, S. ; Meijer, G. J. ; Brosens, L. A. A. ; Ruurda, J. P. ; van Hillegersberg, R.</creator><creatorcontrib>Defize, I. L. ; van der Horst, S. ; Bülbul, M. ; Haj Mohammad, N. ; Mook, S. ; Meijer, G. J. ; Brosens, L. A. A. ; Ruurda, J. P. ; van Hillegersberg, R.</creatorcontrib><description>Background Patients  with esophageal cancer  that invades adjacent structures (cT4b) are precluded from surgery and usually treated with definitive chemoradiotherapy (dCRT). dCRT might result in sufficient downstaging to enable a radical resection, possibly improving survival. This study aimed to assess the perioperative and oncologic outcomes of a salvage robot-assisted minimally invasive esophagectomy (RAMIE) in patients with cT4b esophageal cancer after dCRT. Methods Between June 2012 and November 2019, patients who underwent a RAMIE with a gastric conduit reconstruction after completion of dCRT for cT4b esophageal carcinoma were identified from a prospectively maintained surgical database at the University Medical Center Utrecht. Results In total, 24 patients with a histopathologically confirmed T4b adenocarcinoma or squamous cell carcinoma of the esophagus were included. The adjacent organs involved were the tracheobronchial tree (67%), aorta (21%) or both (13%). No conversions or major intraoperative complications were observed. A radical resection was achieved in 22 patients (92%), and a pathologic complete response was observed in 13 (54%) patients. Postoperative grade 2 or higher complications occurred in 20 patients (83%). The disease-free survival at 24 months was 68% for the patients in whom a radical resection was achieved. Conclusion In patients with cT4b esophageal cancer treated with dCRT followed by a salvage RAMIE, a radical resection rate of 92% was achieved, with acceptable complications and promising survival rates. These results demonstrate the feasibility of a curative surgical treatment for patients with initially irresectable esophageal cancer but underscore the importance of a proper preoperative patient selection.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-020-09425-2</identifier><identifier>PMID: 33341917</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adenocarcinoma ; Aorta ; Boehmeria ; Chemoradiotherapy ; Chemotherapy ; Esophageal cancer ; Esophageal carcinoma ; Esophageal Neoplasms - surgery ; Esophagectomy ; Esophagus ; Gastrointestinal surgery ; Humans ; Medicine ; Medicine &amp; Public Health ; Oncology ; Patients ; Radiation therapy ; Robotic surgery ; Robotics ; Salvage Therapy ; Squamous cell carcinoma ; Surgery ; Surgical Oncology ; Thoracic Oncology ; Treatment Outcome</subject><ispartof>Annals of surgical oncology, 2021-05, Vol.28 (5), p.2730-2738</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. 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L.</creatorcontrib><creatorcontrib>van der Horst, S.</creatorcontrib><creatorcontrib>Bülbul, M.</creatorcontrib><creatorcontrib>Haj Mohammad, N.</creatorcontrib><creatorcontrib>Mook, S.</creatorcontrib><creatorcontrib>Meijer, G. J.</creatorcontrib><creatorcontrib>Brosens, L. A. A.</creatorcontrib><creatorcontrib>Ruurda, J. P.</creatorcontrib><creatorcontrib>van Hillegersberg, R.</creatorcontrib><title>Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background Patients  with esophageal cancer  that invades adjacent structures (cT4b) are precluded from surgery and usually treated with definitive chemoradiotherapy (dCRT). dCRT might result in sufficient downstaging to enable a radical resection, possibly improving survival. This study aimed to assess the perioperative and oncologic outcomes of a salvage robot-assisted minimally invasive esophagectomy (RAMIE) in patients with cT4b esophageal cancer after dCRT. Methods Between June 2012 and November 2019, patients who underwent a RAMIE with a gastric conduit reconstruction after completion of dCRT for cT4b esophageal carcinoma were identified from a prospectively maintained surgical database at the University Medical Center Utrecht. Results In total, 24 patients with a histopathologically confirmed T4b adenocarcinoma or squamous cell carcinoma of the esophagus were included. The adjacent organs involved were the tracheobronchial tree (67%), aorta (21%) or both (13%). No conversions or major intraoperative complications were observed. A radical resection was achieved in 22 patients (92%), and a pathologic complete response was observed in 13 (54%) patients. Postoperative grade 2 or higher complications occurred in 20 patients (83%). The disease-free survival at 24 months was 68% for the patients in whom a radical resection was achieved. Conclusion In patients with cT4b esophageal cancer treated with dCRT followed by a salvage RAMIE, a radical resection rate of 92% was achieved, with acceptable complications and promising survival rates. 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L.</au><au>van der Horst, S.</au><au>Bülbul, M.</au><au>Haj Mohammad, N.</au><au>Mook, S.</au><au>Meijer, G. J.</au><au>Brosens, L. A. A.</au><au>Ruurda, J. P.</au><au>van Hillegersberg, R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2021-05-01</date><risdate>2021</risdate><volume>28</volume><issue>5</issue><spage>2730</spage><epage>2738</epage><pages>2730-2738</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background Patients  with esophageal cancer  that invades adjacent structures (cT4b) are precluded from surgery and usually treated with definitive chemoradiotherapy (dCRT). dCRT might result in sufficient downstaging to enable a radical resection, possibly improving survival. This study aimed to assess the perioperative and oncologic outcomes of a salvage robot-assisted minimally invasive esophagectomy (RAMIE) in patients with cT4b esophageal cancer after dCRT. Methods Between June 2012 and November 2019, patients who underwent a RAMIE with a gastric conduit reconstruction after completion of dCRT for cT4b esophageal carcinoma were identified from a prospectively maintained surgical database at the University Medical Center Utrecht. Results In total, 24 patients with a histopathologically confirmed T4b adenocarcinoma or squamous cell carcinoma of the esophagus were included. The adjacent organs involved were the tracheobronchial tree (67%), aorta (21%) or both (13%). No conversions or major intraoperative complications were observed. A radical resection was achieved in 22 patients (92%), and a pathologic complete response was observed in 13 (54%) patients. Postoperative grade 2 or higher complications occurred in 20 patients (83%). The disease-free survival at 24 months was 68% for the patients in whom a radical resection was achieved. Conclusion In patients with cT4b esophageal cancer treated with dCRT followed by a salvage RAMIE, a radical resection rate of 92% was achieved, with acceptable complications and promising survival rates. These results demonstrate the feasibility of a curative surgical treatment for patients with initially irresectable esophageal cancer but underscore the importance of a proper preoperative patient selection.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>33341917</pmid><doi>10.1245/s10434-020-09425-2</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0003-3250-8936</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adenocarcinoma
Aorta
Boehmeria
Chemoradiotherapy
Chemotherapy
Esophageal cancer
Esophageal carcinoma
Esophageal Neoplasms - surgery
Esophagectomy
Esophagus
Gastrointestinal surgery
Humans
Medicine
Medicine & Public Health
Oncology
Patients
Radiation therapy
Robotic surgery
Robotics
Salvage Therapy
Squamous cell carcinoma
Surgery
Surgical Oncology
Thoracic Oncology
Treatment Outcome
title Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy
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