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Comparison of Transthoracic Esophagectomy with Definitive Chemoradiotherapy as Initial Treatment for Patients with Esophageal Squamous Cell Carcinoma Who Could Tolerate Transthoracic Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The oncological outcomes of transthoracic esophagectomy (TTE) and definitive chemoradiotherapy (dCRT) as initial treatment in patients with esophageal squamous cell carcinoma (ESCC) who could tolerate TTE remains unclear.

Methods

Consecutive patients histologically diagnosed with stage I/II/III ESCC (excluding cT4 or cN3) or stage IV ESCC due to supraclavicular lymph node metastasis were eligible for inclusion in this retrospective study. To select patients who could tolerate TTE, respiratory function, Eastern Cooperative Oncology Group performance status, and preoperative complications were considered. Patient characteristics, recurrence-free survival (RFS), 3- and 5-year overall survival (OS), pattern of recurrence, and treatments after initial treatment failure were investigated.

Results

Overall, 112 patients were included in the TTE group and 65 were included in the dCRT group. No significant differences were observed in patient characteristics and clinical stage between the TTE and dCRT groups (stage I/II/III/IV of 29/27/46/10 in the TTE group and 23/15/20/7 in the dCRT group). The R0 resection rate was 87 % in the TTE group, and complete response rate was 68 % in the dCRT group. In intention-to-treat analysis, there was no significant difference in RFS. In contrast, 3-year OS of non-stage IA patients was significantly longer in the TTE group than the dCRT group (TTE 66.9 %; dCRT 49.8 %; p = 0.023). In non-stage IA patients, after initial treatment failure significantly more patients could undergo local treatment (radiotherapy or surgery in the TTE group; surgery or endoscopic resection or photodynamic therapy in the dCRT group) in the TTE group than the dCRT group (TTE 74 %; dCRT 40 %; p = 0.003).

Conclusions

In locally advanced ESCC patients who could tolerate TTE, TTE extended 3-year OS, which might have been encouraged by utilizing local treatment after initial treatment failure.

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Disclosure

Yuko Kitagawa has the following financial relationships to disclose: research funding from Kyowa Hakko Kirin Co., Ltd, Bristol-Myers Co., Ltd, Nippon Kayaku Co., Ltd, Pfizer Co., Ltd, and Yakult Honsha Co., Ltd.

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Authors and Affiliations

  1. Division of Esophageal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan

    Satoru Matsuda MD, Yasuhiro Tsubosa MD, PhD, Masahiro Niihara MD, Katsushi Takebayashi MD, PhD & Keisuke Kawamorita MD

  2. Division of Upper Gastrointestinal Tract, Department of Surgery, International Medical Center, Saitama University, Saitama, Japan

    Hiroshi Sato MD, PhD

  3. Clinical Trial Coordination Office, Shizuoka Cancer Center Hospital, Shizuoka, Japan

    Keita Mori MSc

  4. Division of Gastrointestinal Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan

    Takahiro Tsushima MD, Tomoya Yokota MD, PhD, Yusuke Onozawa MD & Hirofumi Yasui MD

  5. Division of Radiation Oncology, Shizuoka Cancer Center Hospital, Shizuoka, Japan

    Hirofumi Ogawa MD

  6. Department of Surgery, Keio University School of Medicine, Tokyo, Japan

    Hiroya Takeuchi MD, PhD & Yuko Kitagawa MD, PhD

Authors
  1. Satoru Matsuda MD
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  2. Yasuhiro Tsubosa MD, PhD
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  3. Masahiro Niihara MD
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  4. Hiroshi Sato MD, PhD
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  5. Katsushi Takebayashi MD, PhD
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  6. Keisuke Kawamorita MD
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  7. Keita Mori MSc
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  8. Takahiro Tsushima MD
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  9. Tomoya Yokota MD, PhD
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  10. Hirofumi Ogawa MD
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  11. Yusuke Onozawa MD
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  12. Hirofumi Yasui MD
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  13. Hiroya Takeuchi MD, PhD
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  14. Yuko Kitagawa MD, PhD
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Corresponding author

Correspondence to Yasuhiro Tsubosa MD, PhD.

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Matsuda, S., Tsubosa, Y., Niihara, M. et al. Comparison of Transthoracic Esophagectomy with Definitive Chemoradiotherapy as Initial Treatment for Patients with Esophageal Squamous Cell Carcinoma Who Could Tolerate Transthoracic Esophagectomy. Ann Surg Oncol 22, 1866–1873 (2015). https://doi.org/10.1245/s10434-014-4337-7

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  • DOI: https://doi.org/10.1245/s10434-014-4337-7

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