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Efficiency of conversion surgery for esophageal squamous cell carcinoma with solitary abdominal para-aortic lymph node metastasis

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Abstract

Purpose

Abdominal para-aortic lymph nodes (PANs) are sites of distant metastasis in esophageal squamous cell cancer (ESCC). The prognosis of patients with Stage IVB ESCC and abdominal PAN metastasis is extremely poor. However, chemotherapy for ESCC has recently been developed, and the effectiveness of combined induction therapy and conversion surgery remains unclear. The primary objective of this study was to evaluate the short- and long-term outcomes of conversion surgery for ESCC and solitary abdominal PAN metastases after induction therapy.

Methods

Thirteen patients who underwent conversion esophagectomy for cStage IVB ESCC with solitary abdominal PAN metastasis after induction therapy between January 2017 and October 2022 at our institution were enrolled. The short- and long-term outcomes of conversion surgery were retrospectively evaluated.

Results

Three patients (23.1%) had pathological abdominal PAN metastasis, and six patients (46.2%) without pathological abdominal PAN metastasis showed that chemotherapy eliminated the tumors in the abdominal PAN. Three patients (23.1%) had postoperative complications of Clavien–Dindo grade II or higher. The 3-year overall and recurrence-free survival rates were 83.1% and 51.3%, respectively.

Conclusions

Our findings showed that conversion surgery for ESCC and solitary abdominal PAN metastasis led to a good prognosis when induction therapy was successful.

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Abbreviations

5-FU:

5-Fluorouraci

AC:

Adjuvant chemotherapy

BMI:

Body mass index

C–D:

Clavien–Dindo classification

CI:

Confidential interval

CT:

Computed tomography

ESCC:

Esophageal squamous cell carcinoma

FOLFOX:

Folinic acid, fluorouracil, and oxaliplatin

FP:

5-Fluorouracil and cisplatin

JCOG:

Japan Clinical Oncology Group

LN:

Lymph node

Lt:

Lower thoracic esophagus

NAC:

Neo-adjuvant chemotherapy

N/A:

Not applicable

Mt:

Middle thoracic esophagus

Nivo:

Nivolumab

OS:

Overall survival

PAN:

Para-aortic lymph node

PET–CT:

Positron emission tomography–computed tomography

PR:

Partial response

pR:

Pathological residual tumor

PTX:

Paclitaxel

RECIST:

Response Evaluation Criteria in Solid Tumors

RFS:

Relapse-free survival

RT:

Radiation therapy

SD:

Stable disease

UICC:

Union of international Cancer Control

Ut:

Upper thoracic esophagus

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Acknowledgements

We wish to thank all patients and hospital staff who were involved in this study. We also thank Cathel Kerr, BSc, PhD and H. Nikki March, PhD, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

Funding

None.

Author information

Authors and Affiliations

  1. Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan

    Takashi Shigeno, Daisuke Kajiyama, Kazuma Sato, Naoto Fujiwara & Takeo Fujita

  2. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8519, Japan

    Takashi Shigeno & Yusuke Kinugasa

  3. Esophageal Surgery Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan

    Hiroyuki Daiko

Authors
  1. Takashi Shigeno
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  2. Daisuke Kajiyama
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  3. Kazuma Sato
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  4. Naoto Fujiwara
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  5. Yusuke Kinugasa
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  6. Hiroyuki Daiko
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  7. Takeo Fujita
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Contributions

Study design: TS and TF. Data collection: TS, DK, KS, NF, and TF. Statistical analysis.

Interpretation of results: TS and TF. Drafting of the manuscript: TS. Critical revision of the manuscript for important intellectual content: YK, HD, and TF. Final approval of the manuscript: All authors. Accountability for all aspects of the work: All authors.

Corresponding author

Correspondence to Takeo Fujita.

Ethics declarations

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

All procedures were conducted in accordance with the ethical standards of the respective committees on human experimentation (institutional and national) and the Declaration of Helsinki. This study was approved by the National Cancer Center Research Ethics Review Committee (Research Project Number: 2018–322).

Animal studies

N/A.

Informed consent

Informed consent or its equivalent was obtained from all patients included in the study.

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Supplementary Information

Below is the link to the electronic supplementary material.

595_2024_2872_MOESM1_ESM.pptx

Supplementary file1 Supplemental Figure 1. Abdominal PAN images of all 13 patients using contrast-enhanced computed tomography and positron emission tomography-computed tomography (PPTX 14192 KB)

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Shigeno, T., Kajiyama, D., Sato, K. et al. Efficiency of conversion surgery for esophageal squamous cell carcinoma with solitary abdominal para-aortic lymph node metastasis. Surg Today (2024). https://doi.org/10.1007/s00595-024-02872-4

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  • DOI: https://doi.org/10.1007/s00595-024-02872-4

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