The port site recurrence after a thoracoscopic and video-assisted esophagectomy for advanced esophageal cancer.

INTRODUCTION: Thoracoscopic or video-assisted thoracic esophagectomies have been performed for the last 10 years. Nevertheless, some reports have showed a risk of dissemination with endoscopic or video-assisted surgery for malignant disease. This institute experienced three cases of port site recurrence after a thoracoscopic esophagectomy for advanced esophageal cancer. Following those cases, induction chemo-radiation therapy was performed for patient with advanced esophageal cancer before thoracoscopic or video-assisted esophagectomy. Since introducing induction chemo-radiation therapy, no patients have experienced port site recurrence after a thoracoscopic or video-assisted esophagectomy for advanced esophageal cancer. In this study, the two patients groups are compared before and after the introduction of induction chemo-radiation therapy.

PATIENTS AND METHODS: Between November 1995 and December 2005, thoracoscopic and video-assisted esophagectomies were performed on 112 (72.7%) patients out of 154 who underwent a surgical resection for thoracic and abdominal esophageal cancer. The histologic type of cancer was squamous cell carcinoma in 109 (97.4%) patients and adenocarcinoma in 3 (2.6%). Ninety-one patients were men and 21 were women. The tumor was located in the upper thoracic esophagus in 22 (19.6%) patients, the middle thoracic esophagus in 49 (43.8%), the lower thoracic esophagus in 34 (30.4%), and the abdominal esophagus in 7 (6.2%).

RESULTS: Before December 1999, port site recurrence occurred in three cases of those of 29 patients with clinical T2-T4 esophageal cancer from 3 to 6 months after surgery, and pleural dissemination was observed in two of those patients. Since January 2000, induction chemo-radiation therapy (low-dose fluorouracil and platinum + 40 Gy radiation) has been performed to 31 patients with clinical T2-T4 disease, and port site recurrence has not occurred in any patients who received trimodality therapy.

CONCLUSIONS: We think that the trend toward less port site recurrences with induction therapy should be examined in future studies of video-assisted thoracic surgery esophagectomy to confirm our findings.