Análisis de la morbimortalidad perioperatoria y de la supervivencia en pacientes con cáncer de esófago intervenidos mediante cirugía mínimamente invasiva

Abstract

In spite of the continuous improvements on diagnostic and therapeutic techniques, the long-term survival of patients diagnosed with esophageal cancer is still low. The mainstay treatment for esophageal cancer remains surgical resection, for which outcomes have markedly improved during the recent years. Minimally invasive surgery has recently shown its safety and feasibility for esophageal cancer resection, but available long-term data is still scarce, specially for patients also treated with neoadjuvant chemoradiotherapy protocols. Aim. To evaluate postoperative morbidity, mortality and long-term survival in patients diagnosed with esophageal cancer who underwent minimally-invasive surgery, and to establish their associations with epidemiological, clinical, hystopathologic and therapeutic variables. Methods. Consecutive patients who underwent minimally invasive surgical resections between 2002 and 2012 were retrospectively retrieved and included for analysis. Patients receive surgery either after neoadjuvant treatment or as the first therapeutic step. Patients presenting tumors located at cervical esophagus or presenting advanced disease (T4b, M1) were excluded. Results. 53 patients (48 men/5women) with median age of 60 years were evaluated. Median time from symptoms to diagnosis was 4 months, and the most frequent tumoral subtype found was adenocarcinoma (64%). There were performed 41 transhiatal and 12 three-field esophagectomies, with median operative time of 300 minutes. Two patients (3.8%) required conversion to open surgery and three (5.7%) required a relaparotomy on the postoperative period. Postoperative morbidity rate was 41.5%, being pulmonary complications the most frequently occurred (26.9%). Charlson score ≥4 was significatively associated with its development. Three patients (5.7% ) died during the first 90 postoperative days. 42 (79.2%) patients received preoperative chemo-radiotheraphy, and complete pathologic response rate was 40.5%. Tumoral histologic grade was the only variable showing a statistically significant association with pathologic response grade after neoadjuvant treatment in multivariate analysis. 1- and 5-year overall survival after multimodal treatment were 78.4% and 50%, respectively, and variables associated were tumoral histologic grade (p=0.024), tumoral response grade (p=0.007), and tumoral sterilization (p=0.023). Conclusions. Minimally-invasive esophagectomy for cancer constitutes an alternative with similar perioperative morbi-mortality than conventional open approach, and also presents favourable oncologic outcomes.