OBJECTIVE

To assess the immediate results of combined and independent surgical treatment in patients with thoracic esophageal cancer, by comparing the causes and pattern of postoperative complications and deaths.

SUBJECTS AND METHODS

The experience in treating 267 patients with thoracic esophageal cancer in 2005—2020 was analyzed at the Department of Thoracoabdominal Surgery, P.A. Herzen Moscow Oncology Research Institute. Of these, 150 patients underwent independent surgical treatment and 117 patients received different combined treatment options, including the surgical stage. The groups were matched for gender and age: there was a male dominance; the mean age in both groups was 55 years. The inclusion criteria for the surgical treatment group were a localized tumor process (cT_1—2N₀M₀), a complicated course, elderly age, and/or comorbidity. Combined treatment was performed for a locally advanced tumor process and included preoperative teleradiotherapy (TRT) options (n=23), TRT with radiomodification using 5-fluorouracil and cisplatin (n=38), paclitaxel and carboplatin (n=30); preoperative and perioperative combinations chemotherapy or adjuvant TRT or chemotherapy (n=26). Surgical treatment as both alone and in combination with combined treatment consisted in subtotal esophageal resection with plastic surgery with a stem from the greater curvature of the stomach (n=248), a segment of the small intestine (n=1), colon (n=7); plastic surgery was not done in 11 patients. Immediate results were assessed according to the Clavien—Dindo classification.

RESULTS

The overall rate of postoperative complications was 35%; the postoperative mortality rate was 8.2%; there were no statistically significant differences between the independent surgical and combined treatment groups: the rates of complications and mortality in the independent surgical treatment group were 34 and 10%, respectively; those in the combined treatment group were 36 and 6% (p=0.4191). The most common complication was postoperative pneumonia (20 and 23%, respectively). The rate of esophageal anastomotic failure in the two groups was 4.6 and 4.2%, respectively; whereas a defect in the mechanical suture of the gastric stem was diagnosed in 3.3 and 4.2% of cases, respectively.

CONCLUSION

The study demonstrated that there were no statistically significant differences in the rates of postoperative complications and mortality when comparing the groups of independent surgical treatment and combined treatment for esophageal cancer. A complication as pneumonia was most commonly observed. Esophageal anastomotic failure and gastric stem perforation remain a formidable complication with high mortality rates. The introduction of minimally invasive surgical techniques does not worsen the immediate results of surgical treatment.