Outcomes of Esophagectomy in a Tertiary Care Center in Pakistan

TL;DR

This study examines the outcomes of esophagectomy for esophageal cancer in Pakistan, showing it is feasible with acceptable risks and good cancer treatment results.

Contribution

The study provides the first detailed analysis of esophagectomy outcomes in a Pakistani tertiary care center.

Findings

Most patients had uneventful postoperative recovery, with low rates of major complications and mortality.

Complications were not associated with gender, comorbidities, or cancer type.

The majority of tumors were T3 stage, and most resections were complete (R0).

Abstract

Introduction: Esophageal cancer (EC) is a disease with a poor prognosis. Surgical management, combined with chemoradiotherapy, is the standard management. However, esophagectomy is associated with high morbidity and mortality. There is limited data on esophagectomy and its outcomes in Pakistan. This study aims to address this gap in the literature.

Methodology: A retrospective single-center cohort study was conducted to evaluate patients undergoing esophagectomy for EC during five years, from January 1, 2019, to December 31, 2023. Patients underwent minimally invasive esophagectomy in the form of laparoscopic-assisted Ivor-Lewis esophagectomy, or open surgery, as left thoracoabdominal esophagectomy and transhiatal esophagectomy. Data regarding intraoperative course, postoperative events, complications, and final histopathology reports were evaluated.

Results: A total of 43 patients underwent esophagectomy for EC. The mean age was 62.2 ± 12.1 years, with 31 (72.1%) male patients. Adenocarcinoma was the most common diagnosis, accounting for 27 (62.8%), with squamous cell carcinoma present in the remaining 16 (37.2%) cases. Neoadjuvant therapy was given to 37 (86.0%) patients. Mean operative time was 288 ± 88 minutes. Twenty-six (60.5%) patients had an uneventful postoperative course. Seven (16.3%) patients experienced minor deviations from the routine postoperative course and were classified as grade 1 in the Clavien-Dindo classification. Higher Clavien-Dindo grades were found in 12 (27.9%) cases, indicating greater morbidity. There were no cases of anastomotic leak or chyle leak. There was one reintervention (2.3%) and one mortality (2.3%). There was no association between the development of complications and gender (P = 0.245), presence of comorbidities (P = 0.224), or the histopathological diagnosis (P = 0.555). The majority of cases were T3 tumors, accounting for 21 (48.8%), while the most common grade was grade 2, with 25 (58.1%) cases. Lymph node involvement was absent in 17 (39.5%) patients. The most common final stage was IIIb, found in 19 (44.2%) cases. R0 resection was achieved in 36 (83.7%).

Conclusions: Esophagectomy with reasonable rates of morbidity and sound oncological outcomes is feasible in a developing country like Pakistan. Complications were found to be independent of gender, comorbidities, and the underlying pathology. Larger, prospective, and ideally multicenter studies with a longer follow-up period are needed from this region.