744. LEFT THORACOABDOMINAL ESOPHAGECTOMY: ITS VALIDITY IN MODERN ESOPHAGEAL SURGERY

Abstract Background The optimal surgical approach for the treatment of esophageal and gastroesophageal junction tumors remains elusive. An open left thoracoabdominal approach may prove particularly useful in certain clinical scenarios, mainly because of its versatility and excellent exposure provided. The aim of this study is to present our experience and evaluate the early outcomes related to an open left thoracoabdominal esophagectomy (LTE). Methods A retrospective cohort study of prospectively collected data was conducted from two institutions performing esophageal surgery. Patients with distal esophageal or junctional tumors who underwent an open LTE between November 2018 and December 2023 were included. Primary outcomes were 30-day and in-hospital mortality, postoperative complications, and surrogates of oncological efficacy, including resection margin status and lymph node yield. Complications were recorded using the definitions provided by the Esophagectomy Complications Consensus Group and scored according to the Clavien-Dindo classification. Circumferential resection margin status was based on the definition used by the College of American Pathologists. Results During the study period 22 patients underwent an open LTE with a standard two-field lymphadenectomy. Eight patients (36%) suffered from postoperative complications, with pulmonary complications being the most common (7 patients; 32%). Severe complications (Clavien-Dindo ≥3) occurred in 3 patients. One patient experienced a clinical anastomotic leak. None of the patients required a reoperation or a step-up to a higher level of care. The 30-day and in-hospital mortality were zero. On histological examination, 6 patients (27%) had tumor cells at the surgical margin, most commonly the circumferential resection margin. A mean number of 27 lymph nodes were retrieved. Conclusion This small series demonstrates the applicability of an open left thoracoabdominal approach in everyday surgical practice for the treatment of distal esophageal and gastroesophageal junction tumors. Our results imply that open LTE can be implemented in select patients with acceptable morbidity and oncological efficacy.