Abstract
Background
In patients with locally advanced esophageal cancer who had undergone chemoradiotherapy (CRT), the limitations of radiological evaluation may necessitate surgical exploration to ascertain disease resectability. Upon intraoperative confirmation of T4b disease (sT4b), the optimal management strategy remains unclear. While some surgeons may opt against resection, others advocate for palliative esophagectomy (PE). Regrettably, the current literature does not provide a consensus on the most effective approach for managing these intricate cases.
Methods
The study cohort consisted of 68 patients with esophageal squamous cell carcinoma (ESCC) who presented with sT4b disease following CRT. The perioperative outcomes and overall survival (OS) were compared between patients who underwent PE (n = 56) and those who received an open-close (OC) procedure (n = 12).
Results
Patients who underwent an OC procedure experienced a shorter hospital stay (16.5 vs. 28.8 days; p = 0.052) and showed a non-significant reduction in the rate of major complications (33.9% vs. 25%; p = 0.549) and in-hospital mortality (0% vs. 5.4%; p = 0.412) than those who received PE; however, PE was associated with a superior 2-year OS rate than OC (9.6% vs. 0%; p = 0.009). In multivariable analysis, a pretreatment clinical stage of II/III (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.31−0.87; p = 0.013) and PE with retrosternal reconstruction (HR 0.38, 95% CI 0.15−0.49; p = 0.010) were independently associated with a more favorable OS.
Conclusion
PE with retrosternal reconstruction may be a feasible approach for patients with ESCC exhibiting sT4b disease after CRT.
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Funding
This work was supported by grants from the Chang Gung Memorial Hospital, Taiwan (CORPG3L0331 and CORPG3N0531).
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Tzu-Yi Yang, Chi-Ju Yeh, MD, Chien-Hung Chiu, and Yin-Kai Chao declare they have no conflicts of interest that may be relevant to the contents of this article.
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Yang, TY., Yeh, CJ., Chiu, CH. et al. Survival Outcomes of Patients with Esophageal Cancer and Post-chemoradiotherapy Surgical T4b Disease: Is Palliative Resection Justified?. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15460-0
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DOI: https://doi.org/10.1245/s10434-024-15460-0