Assessment of the status of micrometastasis and tumor spillage among the patients undergoing thoracoscopic esophagectomy for carcinoma esophagus.

BACKGROUND: Esophageal cancer is sixth leading cause of cancer deaths and the eighth most common cancer worldwide. In the recent times, the incidence and mortality rates have increased. To improve the survival in esophageal carcinoma, newer tactics have to be applied to improve outcomes. It is well established that in cases of carcinoma lung and stomach, presence of micrometastasis or spread of tumor cell following surgical manipulation has been shown to predict recurrence and poor prognosis. Similarly, spread of tumor cell during esophagectomy or presence of occult micrometastatic disease in esophageal carcinoma may lead to early tumor recurrence and poor prognosis. The actual incidence of pleural micrometastasis and tumor spillage following thoracoscopic esophagectomy is not clear. The presence of malignant cells in cytologic or immunocytochemical analysis may help in prognostication and further therapeutic decision making. AIM: To assess the incidence of micrometastasis and tumor spillage among the patients undergoing thoracoscopic surgery for esophageal carcinoma. METHODS: An observational study was done at Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry. Nineteen patients aged 18 to 70 years with slight male preponderance, undergoing elective thoracoscopic esophagectomy for esophageal carcinoma were included in this observational study from June 2021 to June 2023. Pre and post dissection pleural cavity lavage was done with 200 mL saline and the fluid was subjected to cytologic and immunocytological examination. The cytology and immunocytological examination report was interpreted as positive for malignant cells or negative for malignant cells. Immunocytological examination was done and evaluated for presence or absence of tumor markers cytokeratin 7 and p40 signifying presence or absence of tumor spillage. RESULTS: Rate of pre dissection fluid was negative for the malignant cell by cytological and immunocytological analysis in all cases indicating no micrometastasis in our group of patients. Rate of post dissection fluid was negative for the malignant cell by cytological and immunocytological analysis in all cases indicating no incidence of tumor spillage post-surgery in our patients. No significant association was found between age, gender, body mass index, site of lesion, histological type, neoadjuvant therapy and tumor-nodes-metastasis staging with pre and post dissection pleural fluid cytological and immunohistochemical analysis in our study. CONCLUSION: This study assessed the incidence of micrometastasis and tumor spillage following minimal invasive esophagectomy could not find any tumor cells in both pre and post dissection samples.