Contemporary Role of Open Left Thoracoabdominal Approach in Esophageal Malignancy Treatment

TL;DR

This study evaluates the safety and effectiveness of open left thoracoabdominal esophagectomy for treating esophageal cancer, finding it to be a viable option with acceptable outcomes.

Contribution

The study provides contemporary evidence supporting the use of open LTE in selected cases of esophageal malignancy.

Findings

Postoperative complications occurred in 36% of patients, primarily pulmonary.

Zero in-hospital and 30-day mortality were observed.

One-year and two-year overall survival rates were 79% and 47%, respectively.

Abstract

Introduction: Despite the widespread use of minimally invasive techniques, open left thoracoabdominal esophagectomy (LTE) can offer excellent visualization and adaptability. The current study aimed to present and evaluate the outcomes related to an open LTE in esophageal malignancy treatment.

Methods: A retrospective cohort analysis of data collected from two institutions was performed, including patients with distal esophageal or junctional tumors who underwent open LTE between November 2018 and December 2023.

Results: Twenty-two patients were included (16 males; mean age 62.8 years). Postoperative complications occurred in eight patients (36%), with pulmonary complications being the most prevalent (seven patients; 32%). One patient experienced a clinical anastomotic leak. No reoperations or escalation to a higher level of care were required. In-hospital and 30-day mortality were zero. Tumor cells were found at the surgical margins in six patients (27%). The mean lymph node yield was 27. During the follow-up period, there were nine deaths and 11 cases of disease recurrence. Isolated locoregional recurrence was seen in five patients (23%). The one-year and two-year overall survival rates were 79% and 47%, respectively.

Conclusion: In selected cases, open LTE remains a valid and safe operation with acceptable morbidity and oncological efficacy.