OGC P34 Oesophageal and Gastro-oesophageal Junctional Cancer Recurrence Post Hybrid and Minimally Invasive Oesophagectomies

Abstract Background Minimally invasive oesophagectomy (MIO) has shown favourable short-term outcomes compared to the open and hybrid alternative, with similar oncological resection rates and mortality. Despite this, there is limited literature on recurrence patterns between operative approaches, with little reported comparing hybrid and minimally invasive oesopahgectomies. This study aimed to evaluate the differences in recurrence patterns between hybrid and totally minimally invasive oesophagectomies. Methods All patients undergoing an Ivor-Lewis oeosphagectomy via a hybrid (HILO) or totally minimally invasive approach were included. Patients received clinical and radiological follow-up with CT chest, abdomen and pelvis at regular intervals or in the presence of concerning symptoms. Propensity matching was performed and matched cohorts were analysed. Statistical analysis was performed using R 4.1.2 Results Forty HILO and 56 MIO patients were included. Overall recurrence was reduced in MIO (50% HILO vs 21% MIO p=0.003, 50% HILO vs 25% MIO, p=0.02 after matching). Distant recurrence was higher in HILO (45% HILO vs 20% MIO p=0.002, 45% HILO vs 23% MIO p=0.02 after matching). For GOJ cancers, there was reduced overall recurrence in MIO compared to HILO (52% HILO vs 9% MIO, p=0.002 overall, 24% hybrid vs 0% MIO, p=0.01 for local recurrence). These differences remained after propensity matching (52% hybrid vs 14% MIO, p=0.02 overall, 24% HILO vs 0% MIO, p=0.046 for locoregional). Conclusions MIO patients showed reduced overall and distant recurrence compared to the hybrid technique, with also reduced locoregional recurrence in an unmatched comparison. Reduced overall and local recurrence was seen in MIO cases for cancer of the GOJ. Resection rates and major complication rate was similar between the modalities. For future studies, an agreed definition on locoregional recurrence would be beneficial, as would a reached consensus on lymphadectomy in oesophagectomy.