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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 8/2018

01-08-2018 | Gastrointestinal Oncology

Comparison of Outcome of Esophagectomy Versus Nonsurgical Treatment for Resectable Esophageal Cancer with Clinical Complete Response to Neoadjuvant Therapy

Authors: Yu Ohkura, MD, Junichi Shindoh, MD, Ph.D, Masaki Ueno, MD, Ph.D, Toshiro Iizuka, MD, Ph.D, Harushi Udagawa, MD, Ph.D

Published in: Annals of Surgical Oncology | Issue 8/2018

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Abstract

Background

Treatment for patients who have achieved clinical complete response (cCR) after neoadjuvant therapy has not been established, and there is no consensus regarding the indications for either esophagectomy or nonsurgical treatment.

Methods

Among 1,545 patients with esophageal cancer at Toranomon Hospital between January 2006 and August 2017, 39 who achieved cCR after neoadjuvant treatment were divided into two groups according to treatment: esophagectomy group (n = 18) and nonsurgical treatment group (n = 21) for comparison.

Results

No significant intergroup difference was observed in baseline characteristics. Pathological complete response was confirmed in 13 (72.2%) of the 18 patients who underwent esophagectomy, whereas residual tumor was detected at the location of primary tumor in 2 (11.1%) patients, and lymph node metastasis was found in 3 (16.7%) patients. Recurrence-free survival (RFS) was significantly longer in the esophagectomy group than in the nonsurgical group (p = 0.002). Disease-specific survival (DSS) was significantly longer in the esophagectomy group (p = 0.007). However, no significant intergroup difference was observed in overall survival estimated based on all deaths, including respiratory failure and aspiration pneumonia (p = 0.451).

Conclusions

With improved diagnostic accuracy, nonsurgical treatment can be an option for patients estimated as cCR after treatment administered in a neoadjuvant setting. However, surgical resection is considered more appropriate because of residual tumor in some patients with cCR and because of superior DSS and RFS following esophagectomy compared with nonsurgical treatment. Future studies must focus on ameliorating late postoperative complications, such as respiratory failure and aspiration pneumonia.
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Metadata
Title
Comparison of Outcome of Esophagectomy Versus Nonsurgical Treatment for Resectable Esophageal Cancer with Clinical Complete Response to Neoadjuvant Therapy
Authors
Yu Ohkura, MD
Junichi Shindoh, MD, Ph.D
Masaki Ueno, MD, Ph.D
Toshiro Iizuka, MD, Ph.D
Harushi Udagawa, MD, Ph.D
Publication date
01-08-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 8/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6437-2

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