371. the feasibility of minimally invasive salvage esophagectomy

Abstract Background The mortality of salvage esophagectomy following definitive chemoradiotherapy for esophageal cancer is reported to be high and the feasibility of a minimally invasive approach for salvage esophagectomy remains unknown. The aim of the study is to investigate the feasibility of a minimally invasive approach for salvage esophagectomy. Methods Consecutive 34 patients including 6 pharyngolaryngectomy with total esophagectomy who underwent salvage esophagectomy for esophageal cancer after chemoradiotherapy of 50Gy or greater between 2011 and 2023 were retrospectively reviewed. Postoperative complications were graded according to the Clavien-Dindo classifications. Our strategy for salvage esophagectomy is as follows; subcarinal dissection and upper mediastinal dissection were omitted unless lymph node involvement was suspected to preserve the tracheal perfusion. Cervical supercharge for the conduit is actively considered if the perfusion is uncertain. Results The median age was 64 (45–78). Clinical T stages were T1/T2/T3/T4: 2/8/19/5. The thoracic approaches are conventional thoracoscopy (n = 23), robot-assisted thoracoscopy (n = 9), and mediastinoscopy (n = 2), and no patients underwent open thoracotomy. Cervical supercharge was performed in 16 (47%) patients. The median operation time and blood loss were 673 min and 101 g, respectively. Severe postoperative complications (≧Grade III) occurred in 4 (12%) patients and any postoperative complications (≧Grade II) occurred in 19 (56%) patients, including 6 (18%) anastomotic leakage and 5 (15%) pneumonia. There was no mortality. The 3- and 5-year overall survival rate was 82% and 69%, respectively. Conclusion The minimally invasive approach for salvage esophagectomy was safe and feasible in terms of short- and long-term outcomes.