| Abstrakt: |
From April 2015 to Apr 2017 (2 years), 25 patients with stage II&III carcinoma of the esophagus, were prospectively enrolled in the study. Statistical analysis was performed by using descriptive and inferential statistics using chi square test/fisher exact test for categorical data. Independent sample t-test to compare mean values between the two groups was used and Paired t-test was used to test the relative change with respect to time. P-value less than 0.05 considered as significant at 95% confidence level. The statistical software SPSS version 16.0 used in the analysis. Age ranged from 36-75yrs, with a mean age of 58.68 and majority of patients were in age group of 51-60yrs. Males were affected more than twice as compared to females (M:F=2.5:1) Most common risk factor was smoking, 59% patients were past or present smoker followed by tobacco chewing in 14% patients, alcohol consumption in 27% patients. All patients presented with Dysphagia(100%), associated with weight loss(48%) and Anorexia(32%). Of which 65% patients had grade 3 dyspahgia and 35% had grade 2 dysphagia. Most common location of tumour in Mid thoracic esophagus(52%), followed by lower thoracic esophagus(36%). Gastro-esophageal junction tumours(siewert type 1 and 2) constitutes about 25% of patient cohort. Among 25 patients, 22(88%) patients had Squamous cell carcinoma histology and 03(12%) patients had adenocarcinoma. Clinical staging with CECT and PET-CT scan 20% were stage II and 80% were stage III. Among 25 patients, majority of patients (68%) received NACCRT, of which all had SCC of Mid/Lower third of Esophagus. 3 patients of Adenocarcinoma and 5 patients of SCC received NACT (32%). None of patient of Adenocarcinoma received NACCRT. Post neoadjuvant therapy 40% of patients were able to eat normal food and 60% patients were able to eat food cut into smallpieces after thorough chewing which was statistically significant (p-0.012). Among the cohort, 23(92%) patients successfully underwent VATS esophagectomy with an R0 Resection. Remaining 2 patients, one required conversion to thoracotomy due to extensive pleural adhesions and other had to be aborted in view of anaesthesia related complication (Desaturation). Mean thoracosocpy duration was 120min Mean operating time 300min Mean blood loss 165ml Mean ICU stay 2.2days 30 day mortality nil. Spectrum of immediate morbidity pneumonia (4%), atrial fibrillation (8%), chyle leak (8%), Neck Anastomotic leak (16%), Hoarseness(12%). Spectrum of late morbidity anastomotic stricture (40%), persistent neck fistula (8%), dumping syndrome (4%), FJ related pain and discharge(20%). Pathologic complete response(pCR) to primary tumour 'T' stage was documented in majority 10(41%) of patients. 58% of patients had complete response in nodal status 'N' stage. N1 was documented in 33%. Average Lymph node harvested per patient is 10. Post NeoAdjuvant therapy patients had statistically significant regression(p<0.01) in staging and majority were stage 1(45%) as per AJCC 8th Edition. Pathologic response as per CAP guideline, tumour regression grade 0 i.e complete absence of tumour cells in primary and Lymphnodes was seen in 33% of specimen, where as presence of residual tumour cells in abundant suggestive of poor response seen in 29% of patients. In our study we found a significant correlation between the SUV% reduction and TRG after analyzing the data of all 24 patients in both NACCRT and NACT group with a significance value of 0.031. ROC curve analysis for prediction of histopathologic response by SUV?% of our data showed an AUC of 0.754 and sensitivity and specificity of 18FFDG PET scan of 78.6% and 60% respectively with cut-off of 63%. [ABSTRACT FROM AUTHOR] |
