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Retrospective review of operated carcinoma esophagus - our institutional experience Aim:- To assess the outcome of carcinoma esophagus operated in our institute. Materials and methods:- A retrospective analysis of 210 patients of carcinoma esophagus operated in between 2010-2016 in our institute. Patients were evaluated in terms of neo-adjuvant treatment, surgery, post surgical results and follow-up. Patients of carcinoma esophagus clinical stage ? T2 were considered. Advanced cases, cases with other histology (Leiomyoma, NET and Sarcomatoid Carcinoma), and patients taken other regimen of treatment before surgery like (curative CTRT, palliative RT etc) are excluded from the study Results:- Mean age of presentation was 51.7 year. 56.4% are Male and 43.6% female. 30.5 %(64) patient mid 1/3rd, 36%(76) patient lower 1/3rd and 33.5%(70) patient have GE Junction tumor. 74.8% were Squamous cell carcinoma and 25.2% adenocarcinoma in all three regions SCC was main histological type. 56.7%(119) patients were Upfront operated, 25.3%(53) received NACT(neo-adjuvant chemotherapy) and 18%(38) received NACT+ RT(neo-adjuvant chemo-radiation) Most common drug used in NACT was combination of PACLITAXEL+CARBOPLATIN, and most common NACTRT regimen was 45GY/25# radiation in combination with weekly single agent carboplatin for a duration of 5 weeks. Dose of radiation was adjusted in some patients according to their BMI and performance status. 18.5 %(22) patient were inoperable in Upfront surgery group, 11.3%(6) in NACT group, and 18.4%(7) in NACTRT group. Commonest cause of inoperability was disease adherent to trachea, bronchus and celiac axis. 48.5 %(47) patient were node positive in Upfront surgery group, 42.5%in NACT and NACTRT had the lowest 29% node positivity rate on final Histopathology . PCR(Primary complete response) was highest 29% in NACTRT group .Average blood loss during surgery was highest in NACTRT group(295 ml in Upfront surgery, 332 ml in NACT, 436 ml in NACTRT) Average Hospital stay and ICU stay was comparable in all three group. Most common complication in post operative period was pulmonary followed by anastomotic leak. Recurrence is highest in NACT group (42.5%) and lowest in NACTRT group (16%). The most common site of recurrence was systemic liver, Lung and bone being commonest. 76 patients included in the study are still alive Discussion:- Thus NACT+RT has shown the best outcome in terms of survivorship as 71%(27) patients are still alive, Lowest recurrence rate and highest 29% PCR rate among the group . The only drawback is that NACTRT has higher intraoperative blood loss. CONCLUSION:- our study favours NACT+RT followed by surgery to be the best treatment modality for carcinoma esophagus patients with the least recurrence and better survival. DATA TABLE ( UPFRONT ) Total Patients ---- 119 Gender Ratio (M:F) ---- 67:52 Mean Age in years ---- 55(M), 50.5(F) Operable patients ----- 97 Histopathology ---- Adeno CA - 31, SCC - 88 Surgery: (THE, LAP THE, 3Stage, Ivor Lewis, Thoracolaparoscopic) THE = 37 LAP THE = 4 Thoraco-Lap- Eso= 25 Open Three stage E= 21 Ivor Lewis = 10 INOPERABLE = 22 Anastamosis (Hand Sewn: Stapler) --- 82:15 No. Of Nodes retrieved ---- 10 Adverse Prognostic Factors (PNE/PNI/LVI) ---- PNE = 14, PNI = 10, LVI = 22 Early Complications ---- Pulmonary: 19 (16%), Leak: 16 (16%), Other: 5 (4.2%), Hoarseness : 10 Recurrence ---- Local :3, Regional : 11, Systemic : 21 Stage ---- PCR - 0, 0 - 0, I - 10, II - 42, III - 45 Site ---- Mid - 31, Lower - 50, GEJ - 38 Average Blood Loss ---- 295 ml Average hospital stay ---- 14 days Average ICU stay ---- 5 days Patients still alive ---- 33(27. 7%) ( NACT ) Total Patients ---- 53 Gender Ratio (M:F) ---- 31:22 Mean Age in years ---- 51(M), 48(F) Operable patients ----- 47 Histopathology ---- Adeno CA - 18, SCC - 35 Surgery: (THE, LAP THE, 3Stage, Ivor Lewis, Thoracolaparoscopic) THE = 23 LAP THE = 3 Thoraco-Lap- Eso= 8 Open Three stage E= 12 Ivor Lewis = 1 INOPERABLE = 6 Anastamosis (Hand Sewn: Stapler) --- 39:8 No. Of Nodes retrieved ---- 10 Adverse Prognostic Factors (PNE/PNI/LVI) ---- PNE = 9, PNI = 2, LVI = 15 Early Complications ---- Pulmonary: 14 (26%), Leak: 5 (10.6%), Other: 3 (5.6%), Hoarseness : 12 Recurrence ---- Local :0, Regional : 8, Systemic : 12 Stage ---- PCR - 2, 0 - 0, I - 9, II - 20, III - 16 Site ---- Mid - 18, Lower - 15, GEJ - 20 Average Blood Loss ---- 332 ml Average hospital stay ---- 13 days Average ICU stay ---- 4 days Patients still alive ---- 16(30%) ( NA CTRT ) Total Patients ---- 38 Gender Ratio (M:F) ---- 22:16 Mean Age in years ---- 49.3(M), 48.6(F) Operable patients ----- 31 Histopathology ---- Adeno CA - 4, SCC - 34 Surgery: (THE, LAP THE, 3Stage, Ivor Lewis, Thoracolaparoscopic) THE = 8 LAP THE = 1 Thoraco-Lap- Eso= 4 Open Three stage E= 17 Ivor Lewis = 1 INOPERABLE = 7 Anastamosis (Hand Sewn: Stapler) --- 23:8 No. Of Nodes retrieved ---- 9 Adverse Prognostic Factors (PNE/PNI/LVI) ---- PNE = 2, PNI = 1, LVI = 0 Early Complications ---- Pulmonary: 8 (21%), Leak: 2 (6.4%), Other: 5 (13%), Hoarseness : 10 Recurrence ---- Local : 0, Regional : 1, Systemic : 4 Stage ---- PCR - 8, 0 - 1, I - 8, II -10, III -4 Site ---- Mid - 15, Lower - 11, GEJ - 12 AverageBlood Loss ---- 436 ml Average hospital stay ---- 14 days Average ICU stay ---- 4 days Patients still alive ---- 27 (71%). [ABSTRACT FROM AUTHOR]