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Investigation of operative outcomes of thoracoscopic esophagectomy after triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for advanced esophageal squamous cell carcinoma

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Abstract

Background

Preoperative chemotherapy with cisplatin and 5-fluorouracil (CF) has become the standard treatment for resectable stage II/III thoracic esophageal carcinoma in Japan. Recently, preoperative triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) has been reported to be effective for locally advanced esophageal cancer. Thoracoscopic esophagectomy (TE) has been increasingly accepted worldwide for the treatment of esophageal cancer. We conducted a retrospective study to evaluate the safety and outcomes of TE after DCF therapy for patients with advanced esophageal cancer.

Methods

The medical records of 63 consecutive patients with esophageal squamous cell carcinoma who underwent thoracoscopic surgery after chemotherapy were reviewed. Thirty-four patients received neoadjuvant chemotherapy with CF, and 29 received DCF as first-line chemotherapy.

Results

The clinical T stage was significantly higher in the DCF group than in the CF group (p < 0.0001), including 17 patients with T4. Lymph node metastasis was more frequent in the DCF group (p = 0.0005), and the clinical stage of the tumor was significantly higher in the DCF group than in the CF group (p = 0.0001). No significant difference existed between the two groups in operation time for the thoracic procedure (DCF 277.2 min vs. CF 302 min). Blood loss during the thoracic procedure was less in the DCF group than in the CF group (DCF 46.9 mL vs. CF 88.8 mL; p = 0.0056). No significant differences existed between the two groups in postoperative morbidity (DCF 34.5% vs. CF 47%) or mortality (DCF 0% vs. CF 2.9%) rates.

Conclusions

Our study suggests that TE after DCF therapy for advanced esophageal cancer is as safe as TE after CF therapy.

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Authors and Affiliations

  1. Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, 020-8505, Iwate, Japan

    Yuji Akiyama, Takeshi Iwaya, Fumitaka Endo, Takehiro Chiba, Takeshi Takahara, Koki Otsuka, Hiroyuki Nitta, Keisuke Koeda, Masaru Mizuno & Akira Sasaki

  2. Department of Palliative Medicine, Iwate Medical University School of Medicine, Morioka, Iwate, Japan

    Yusuke Kimura

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  1. Yuji Akiyama
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Correspondence to Yuji Akiyama.

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Yuji Akiyama, Takeshi Iwaya, Fumitaka Endo, Takehiro Chiba, Takeshi Takahara, Koki Otsuka, Hiroyuki Nitta, Keisuke Koeda, Masaru Mizuno, Yusuke Kimura, and Akira Sasaki have no conflicts of interest or financial ties to disclose.

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Akiyama, Y., Iwaya, T., Endo, F. et al. Investigation of operative outcomes of thoracoscopic esophagectomy after triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for advanced esophageal squamous cell carcinoma. Surg Endosc 32, 391–399 (2018). https://doi.org/10.1007/s00464-017-5688-5

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