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Thoracic endovascular aortic repair for esophageal cancer invading the thoracic aorta: a questionnaire survey study

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Abstract

Background

Locally advanced esophageal cancer occasionally invades the aorta, and hemorrhage from the esophagoaortic fistula can cause sudden death. Thoracic endovascular aortic repair (TEVAR) enables hemostasis in such cases, and prophylactic TEVAR can prevent fatal hemorrhagic events during treatment. However, its efficacy in Japan has not been evaluated. This study aimed to clarify the clinical significance of TEVAR in esophageal cancer patients.

Methods

The Japan Esophageal Society conducted a questionnaire survey targeting authorized or semi-authorized member institutes of the Authorized Institutes for Board Certified Esophageal Surgeons. Patients who underwent TEVAR for esophageal cancer were identified from 19 institutes. Data on patient demographics, treatment performed, and survival rate were obtained using the questionnaire. The Kaplan–Meier method was used for survival analysis and to compare differences in survival rates between those who underwent TEVAR for hemorrhage and those for preoperative prophylaxis.

Results

Of the 41 patients identified, 20 patients underwent TEVAR for hemorrhage or impending hemorrhage from the esophagoaortic fistula, while 21 patients underwent TEVAR as preoperative prophylaxis. The median survival time after TEVAR was 135 days in the hemorrhage or impending hemorrhage group and 378 days in the preoperative prophylaxis group. Eighteen patients underwent esophagectomy after TEVAR. No hemorrhagic event was observed during the perioperative period. The median survival time of the patients who underwent esophagectomy was 373 days. Some patients who achieved R0 resection obtained long-term survival.

Conclusion

TEVAR is an efficacious modality to control a life-threatening hemorrhage from esophagoaortic fistula and helps to prolong the survival of patients with locally advanced esophageal cancer invading the aorta.

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Acknowledgements

The authors wish to thank all participating centers, particularly those who provided patient data: Hiroyuki Kitagawa (Kochi University, Kochi); Shinsuke Takeno (Miyazaki University, Miyazaki); Akira Tangoku (Tokushima University, Tokushima); Yuichiro Doki (Osaka University, Osaka); Yasuaki Nakajima (Tokyo Medical and Dental University, Tokyo); Shigeo Aoki (Tuchiura Kyodo Hospital, Ibaraki); Katsuji Hisakura (Tsukuba University, Ibaraki); Hitoshi Fujiwara (Kyoto Prefectural University of Medicine, Kyoto); Takushi Yasuda (Kindai University, Osaka); Masahiko Yano (Osaka International Cancer Institute, Osaka); Hideo Baba (Kumamoto University, Kumamoto); Tomotaka Shibata (Oita University, Oita); and Harushi Udagawa (Toranomon Hospital, Tokyo).

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Authors and Affiliations

  1. The Japan Esophageal Society, 2-3-13 Taihei, Sumida-ku, Tokyo, 103-0012, Japan

    Masayuki Watanabe, Masanobu Nakajima, Katsunori Nishikawa, Hiroyuki Kato & Hisahiro Matsubara

  2. Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

    Masayuki Watanabe

  3. First Department of Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan

    Masanobu Nakajima

  4. Department of Surgery, The Jikei University School of Medicine, Nishi-Shimbashi, Tokyo, Japan

    Katsunori Nishikawa

  5. Department of Surgery, Kiryu Kosei General Hospital, Kiryu, Gunma, Japan

    Hiroyuki Kato

  6. Department of Frontier Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

    Hisahiro Matsubara

Authors
  1. Masayuki Watanabe
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  2. Masanobu Nakajima
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  3. Katsunori Nishikawa
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  4. Hiroyuki Kato
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  5. Hisahiro Matsubara
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Corresponding author

Correspondence to Masayuki Watanabe.

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Ethical Statement

All procedures were in accordance with the ethical standards of the responsible committee on human experimentation and comply with the Helsinki Declaration of 1964 and all subsequent versions.

Conflict of interest

Watanabe M, Nakajima M, Nishikawa K, Kato H, and Matsubara H declare that they have no conflicts of interest.

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Watanabe, M., Nakajima, M., Nishikawa, K. et al. Thoracic endovascular aortic repair for esophageal cancer invading the thoracic aorta: a questionnaire survey study. Esophagus 17, 74–80 (2020). https://doi.org/10.1007/s10388-019-00696-7

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  • DOI: https://doi.org/10.1007/s10388-019-00696-7

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