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Non-curative resection for surgical T4b esophageal cancer: esophagectomy or non-esophagectomy?

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Abstract

Background

Recently, with the development of multidisciplinary treatment, the treatment outcomes of esophageal cancer (EC) have improved. However, despite advances in diagnostic imaging modalities, preoperative diagnosis of T4 EC is still difficult, and the prognosis of T4 EC remains very poor. In addition, the prognosis of surgical T4b EC (sT4b EC) after surgery remains unclear. In this study, we retrospectively reviewed sT4b EC.

Methods

We evaluated the clinical course of sT4b EC and compared palliative esophagectomy with R2 resection (PE group) with other procedures without esophagectomy (NE group) (e.g., only esophagostomy) for sT4b EC.

Results

Forty-seven patients with thoracic EC underwent R2 resection at our institution between January 2009 and December 2020. Thirty-four patients were in the PE group, and 13 patients were in the NE group. The 2-year overall survival rate was 0% in the PE group and 20.2% in the NE group (p = 0.882). There was one case of long-term survival in the NE group that underwent surgery followed by definitive chemoradiation. Postoperative complications (Clavien–Dindo grade ≥ 3) were observed in 25 patients (73.5%) in the PE group and in three patients (23.1%) in the NE group (p = 0.031). The median time to the initiation of postoperative treatment was 68.1 days in the PE group and 18.6 days in the NE group (p = 0191).

Conclusions

If EC is diagnosed as sT4b, palliative esophagectomy should be avoided because of the high complication rate and the lack of long-term survival.

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Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank Editage (www.editage.jp) for the English language review. The authors would like to thank Takako Koshika and Yoko Asahi, staff members at the Department of Esophageal Surgery, National Cancer Center Hospital, for their help in the preparation of this manuscript.

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Authors and Affiliations

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

    Yusuke Fujii, Hiroyuki Daiko, Kentaro Kubo, Kyohei Kanematsu, Daichi Utsunomiya, Daisuke Kurita, Koshiro Ishiyama & Junya Oguma

  2. Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Yusuke Fujii & Hiroyuki Daiko

  3. Gastroenterological Surgery, Hyogo Prefectural Harima-Himeji General Medical Center, 3-264 Kamiya-cho, Himeji, Hyogo, 670-8560, Japan

    Yusuke Fujii

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  1. Yusuke Fujii
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Contributions

Conception and design of the study: Y. Fujii, H. Daiko, and J. Oguma. Acquisition of data: Y. Fujii, K. Kubo, K. Kanematsu, D. Utsunomiya, D. Kurita, and K. Ishiyama. Analysis and/or interpretation of data: Y. Fujii, H. Daiko, and J. Oguma. Drafting the manuscript: Y. Fujii and H. Daiko. Revising the manuscript critically for important intellectual content: H. Daiko. Approval of the version of the manuscript to be published: Y. Fujii, H. Daiko, K. Kubo, K. Kanematsu, D. Utsunomiya, D. Kurita, K. Ishiyama, and J. Oguma.

Corresponding author

Correspondence to Hiroyuki Daiko.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Fujii, Y., Daiko, H., Kubo, K. et al. Non-curative resection for surgical T4b esophageal cancer: esophagectomy or non-esophagectomy?. Langenbecks Arch Surg 408, 201 (2023). https://doi.org/10.1007/s00423-023-02940-2

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