Abstract
The objective of this study is to evaluate the efficacy of multimodal management for esophageal cancer in a high-volume medical center in Latin America. In addition, we analyze the impact of the surgical learning curve by examining the outcomes during 3 time periods.
We conducted a retrospective study of esophageal cancer patients in 3 time periods: 2014 to 2017, 2018 to 2020, and 2021 to 2022. Endpoints: resection type, complications (Clavien system), procedure morbidity/mortality, histological type, LOS, and R0 resectability. Median follow-up: 38 months (r: 6-138). Fisher’s exact test was used to analyze differences in complication rates between periods.
A total of 113 (53 in period 1, 42 in period 2, and 15 in period 3) patients received multimodal therapy for esophageal cancer, with 80% of the patients being men. Of these patients, 74.5% had adenocarcinoma, 19% had squamous cell carcinoma, and 6.3% had other diagnoses. Esophagectomy was performed in 71 cases with intrathoracic anastomosis (IL), while 38 cases underwent cervical anastomosis (McKeown). Hybrid techniques were used in 4 cases. R0 was achieved in 98.1%. The median LOS was 11 days (r: 5-60).
Complications of grade III occurred in 22% of patients, while grade IV complications occurred in 11.8% of patients. The distribution of complications across different periods of time was as follows: Anastomotic Leakage: 20% in first period, 13% in second, and 6% in third (P = .43) for group 1vs3 Graft necrosis: 9%; 8%; and 0% respectively (P = .53) Pneumonia: 13%; 8%; and 6% respectively (P = .52) Mortality: 5%; 5%, and 0% respectively (P = .491).
Multidisciplinary treatment for esophageal cancer is feasible, but effective organization of perioperative care is crucial. The findings suggest a tendency to decrease in leakage and graft necrosis rates, it is not statistically significant. A larger sample in the third period could help confirm this trend. The study emphasizes the importance of a comprehensive and coordinated approach for better outcomes.