BACKGROUND: We hypothesized that the survival rate of patients undergoing R0 esophagectomy after induction chemotherapy or chemoradiotherapy for unresectable T4 esophageal cancer (URT4) would be similar to that of patients undergoing esophagectomy for immediately resectable esophageal cancer with no unfavorable prognostic factors (RNU). METHODS: Between April 2002 and June 2012, 87 of 283 patients with esophageal cancer who presented at the University Hospital of the Ryukyus were enrolled in this prospective cohort study. Tumors were classified as RNU and URT4 in 44 and 43 of the 87 patients, respectively. Outcomes of treatment for URT4 patients were compared with those of RNU patients. RESULTS: The R0 resection rate (61 %) and in-hospital mortality rate (20 %) of URT4 patients were significantly poorer than those of RNU patients (98 and 2.3 %, respectively), although the morbidity rate was similar in the two groups (63 and 52 %, respectively). The 5-year survival rate (35 %) of URT4 patients was significantly poorer than that of RNU patients (67 %) in the intention-to-treat analysis. However, no significant difference was noted between the two survival curves for cases of R0 resection (5-year survival rate, 60 % vs. 69 %). Multivariate analysis revealed R status as the only significant independent prognostic factor for URT4 patients (P < 0.001; hazard ratio = 8.279). CONCLUSIONS: Satisfactory survival rates can be achieved if R0 resection is performed after induction treatment in patients with T4 esophageal cancer, although secondary radical esophagectomy is associated with a higher risk of in-hospital mortality.
BACKGROUND: We hypothesized that the survival rate of patients undergoing R0 esophagectomy after induction chemotherapy or chemoradiotherapy for unresectable T4 esophageal cancer (URT4) would be similar to that of patients undergoing esophagectomy for immediately resectable esophageal cancer with no unfavorable prognostic factors (RNU). METHODS: Between April 2002 and June 2012, 87 of 283 patients with esophageal cancer who presented at the University Hospital of the Ryukyus were enrolled in this prospective cohort study. Tumors were classified as RNU and URT4 in 44 and 43 of the 87 patients, respectively. Outcomes of treatment for URT4 patients were compared with those of RNUpatients. RESULTS: The R0 resection rate (61 %) and in-hospital mortality rate (20 %) of URT4 patients were significantly poorer than those of RNUpatients (98 and 2.3 %, respectively), although the morbidity rate was similar in the two groups (63 and 52 %, respectively). The 5-year survival rate (35 %) of URT4 patients was significantly poorer than that of RNUpatients (67 %) in the intention-to-treat analysis. However, no significant difference was noted between the two survival curves for cases of R0 resection (5-year survival rate, 60 % vs. 69 %). Multivariate analysis revealed R status as the only significant independent prognostic factor for URT4 patients (P < 0.001; hazard ratio = 8.279). CONCLUSIONS: Satisfactory survival rates can be achieved if R0 resection is performed after induction treatment in patients with T4 esophageal cancer, although secondary radical esophagectomy is associated with a higher risk of in-hospital mortality.
Authors: T Nishimaki; O Tanaka; N Ando; H Ide; H Watanabe; M Shinoda; W Takiyama; H Yamana; K Ishida; K Isono; M Endo; T Ikeuchi; T Mitomi; H Koizumi; M Imamura; T Iizuka Journal: Ann Thorac Surg Date: 1999-12 Impact factor: 4.330
Authors: E Ancona; A Ruol; C Castoro; V Chiarion-Sileni; S Merigliano; S Santi; L Bonavina; A Peracchia Journal: Ann Surg Date: 1997-12 Impact factor: 12.969
Authors: M Yano; T Tsujinaka; H Shiozaki; M Inoue; Y Doki; M Yamamoto; E Tanaka; T Inoue; M Monden Journal: J Surg Oncol Date: 1999-01 Impact factor: 3.454
Authors: James Welsh; Stephen H Settle; Arya Amini; Lianchun Xiao; Akihiro Suzuki; Yuki Hayashi; Wayne Hofstetter; Ritsuko Komaki; Zhongxing Liao; Jaffer A Ajani Journal: Cancer Date: 2011-10-05 Impact factor: 6.860
Authors: K Kaneko; H Ito; K Konishi; T Kurahashi; T Ito; A Katagiri; T Yamamoto; T Kitahara; Y Mizutani; A Ohtsu; K Mitamura Journal: Br J Cancer Date: 2003-01-13 Impact factor: 7.640
Authors: Costanza Chiapponi; Felix Berlth; Patrick S Plum; Christopher Betzler; Dirk L Stippel; Felix Popp; Christiane J Bruns Journal: Visc Med Date: 2017-02-15
Authors: Peter S N van Rossum; Nadia Haj Mohammad; Frank P Vleggaar; Richard van Hillegersberg Journal: Nat Rev Gastroenterol Hepatol Date: 2017-12-13 Impact factor: 46.802
Authors: Vignesh Raman; Oliver K Jawitz; Soraya L Voigt; Norma E Farrow; Chi-Fu J Yang; Thomas A D'Amico; David H Harpole Journal: Ann Thorac Surg Date: 2019-07-26 Impact factor: 4.330