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Is there room for improvement in oesophageal cancer surgery? Results of a prospective protocol for individualization of surgical treatment

  • Prospective Clinical Study
  • Published:
Hellenic Journal of Surgery

Abstract

Background

Despite improvements in the multimodality approach, overall survival of oesophageal cancer (EC) remains very low. Given the rarity of the disease and the lack of large prospective studies, controversy still surrounds the optimal type of surgery and the use of adjuvant and neoadjuvant therapy. Traditionally, the debate concerning the extent of lymphadenectomy is between transhiatal oesophagectomy with 1-field lymphadenectomy (THE-1FL) and transthoracic oesophagectomy with 2-field lymphadenectomy (TTE-2FL). The purpose of this study is to evaluate the effect of optimal patient selection for submission to each procedure in terms of overall survival.

Methods

Patients with EC were prospectively enrolled in a database, and a protocol of individualized surgical treatment of EC (PISTEC) was applied to patients with resectable disease. The PISTEC is based on the patient’s physical status and disease stage, with intent to select the appropriate surgical procedure for each patient.

Results

From 01/2006 to 12/2011, 61 patients with EC were individualized according to the PISTEC, of whom 52.4% were submitted to THE-1FL and 31.1% to TTE-2FL. The 30-day mortality rate was 4.9%. The 5-year overall survival rate was 54.9%, and recurrence was observed in 27.5% of patients. The estimated 5-year overall survival of patients with stages 0, I, II, III and IV was 100%, 100%, 92.9%, 45% and 0%, respectively.

Conclusion

The algorithm proposed by the PISTEC aims at balancing perioperative risks with oncological benefit. When the type of surgery is individualized, the outcomes regarding survival are favourable. This effect could probably be enhanced with the concurrent application of neoadjuvant treatment.

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Authors and Affiliations

  1. Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, “Hippocration” General Hospital of Athens, Athens, Greece

    G. Doulami, S. Triantafyllou, N. Memos, N. Kokoroskos & N. Hasemaki

  2. Department of Foregut Surgery, 1st Propaedeutic Surgical Clinic, “Hippocration” General Hospital of Athens, Athens, Greece

    S. Katsaragakis, G. Zografos & D. Theodorou

  3. 114 Vas. Sofias Av., 11527, Athens, Greece

    G. Doulami

Authors
  1. G. Doulami
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  2. S. Triantafyllou
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  3. N. Memos
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  4. N. Kokoroskos
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  5. N. Hasemaki
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  6. S. Katsaragakis
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  7. G. Zografos
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  8. D. Theodorou
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Correspondence to G. Doulami.

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Doulami, G., Triantafyllou, S., Memos, N. et al. Is there room for improvement in oesophageal cancer surgery? Results of a prospective protocol for individualization of surgical treatment. Hellenic J Surg 87, 368–376 (2015). https://doi.org/10.1007/s13126-015-0243-0

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  • DOI: https://doi.org/10.1007/s13126-015-0243-0

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