Skip to main content

Advertisement

SpringerLink
Log in

Prognostic Factors and Appropriate Lymph Node Dissection in Salvage Esophagectomy for Locally Advanced T4 Esophageal Cancer

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

Abstract

Background

A suitable treatment strategy for esophageal cancer after definitive chemoradiotherapy for T4 cases has not been established and remains unclear. This study aimed to clarify the independent prognostic factors, surgical indications, and optimal extent of lymphadenectomy for T4 esophageal cancer.

Methods

Of 803 patients who underwent esophagectomy for esophageal cancer at the authors’ institution from 2006 to March 2018, the study included 33 patients who underwent salvage esophagectomy with locally advanced T4 cancer. The study examined the baseline attributes and treatment results of these cases and evaluated the prognostic factors and treatment strategies.

Results

The independent favorable prognostic factors in T4 cancer (T4a/T4b = 11/22) included non-T4b status [hazard ratio (HR), 15.311; 95% confidence-interval (CI), 1.277–183.5] and R0 resection (HR, 14.706; 95% CI, 1.193–166.67). For the cases in which R0 resection was possible (n = 14), both the 1- and 5-year survival rates were 90.9%, whereas for the cases without R0 dissection (n = 19), the 1- and 5-year survival rates were respectively 44.9% and 0%. In the univariate analysis, the patients who underwent two- or three-field lymph node dissection tended to have a better prognosis (p = 0.062), and those with 60 or more lymph nodes dissected had a significantly better prognosis (p = 0.038). For the patients who underwent salvage esophagectomy with typical lymph node dissection, the rate of complications classified as Clavien–Dindo grade 3 or higher (33.3%) was not increased, indicating that the procedure was relatively safe.

Conclusions

The results showed that in salvage esophagectomy for T4 esophageal cancer, R0 resection led to improved prognosis. Because typical two- or three-field lymph node dissection including prophylactic dissection could be performed safely and led to a better prognosis in salvage esophagectomy, typical esophagectomy including prophylactic lymph node dissection should be performed if possible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kato K, Muro K, Minashi K, et al. Phase II study of chemoradiotherapy with 5-fluorouracil and cisplatin for stage II–III esophageal squamous cell carcinoma: JCOG trial (JCOG 9906). Int J Radiat Oncol Biol Phys. 2011;81:684–90.

    Article  CAS  PubMed  Google Scholar 

  2. Makino T, Doki Y. Treatment of T4 esophageal cancer: definitive chemoradiotherapy vs chemo-radiotherapy followed by surgery. Ann Thorac Cardiovasc Surg. 2011;17:221–8.

    Article  PubMed  Google Scholar 

  3. Kaneko K, Ito H, Konishi K, et al. Definitive chemoradiotherapy for patients with malignant stricture due to T3 or T4 squamous cell carcinoma of the oesophagus. Br J Cancer. 2003;88:18–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Sobin LH, Gospodarowicz MK, Wittekind C. International Union Against Cancer. Oesophagus including oesophagogastric junction. In: Sobin LH, Gospodarowicz MK, Wittekind C, editors. TNM classification of malignant tumours. West Sussex: Wiley-Blackwell; 2009, p. 66–72.

    Google Scholar 

  5. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ajani JA, Winter K, Komaki R, et al. Phase II randomized trial of two nonoperative regimens of induction chemotherapy followed by chemoradiation in patients with localized carcinoma of the esophagus: RTOG 0113. J Clin Oncol. 2008;26:4551–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kiyozumi Y, Yoshida N, Ishimoto T, et al. Prognostic factors of salvage esophagectomy for residual or recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy. World J Surg. 2018 (Epub ahead of print).

  8. Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus, April 2012 edited by the Japan Esophageal Society. Esophagus. 2015;12:1–30.

    Article  PubMed  Google Scholar 

  9. Therasse P, Arbuck S, Eisenhauer E, et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst. 2000;92:205–16.

    Article  CAS  PubMed  Google Scholar 

  10. Eisenhauer E, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.

    Article  CAS  PubMed  Google Scholar 

  11. Japanese Esophageal Society. Japanese classification of esophageal cancer, 11th ed. Parts II and III. Esophagus. 2017;14:37–65.

    Article  Google Scholar 

  12. Japanese Esophageal Society. Japanese classification of esophageal cancer, 11th ed. Part I. Esophagus. 2017;14:1–36.

    Article  Google Scholar 

  13. Nakamura T, Hayashi K, Ota M, et al. Salvage esophagectomy after definitive chemotherapy and radiotherapy for advanced esophageal cancer. Am J Surg. 2004;188:261–6.

    Article  PubMed  Google Scholar 

  14. Tomimaru Y, Yano M, Takachi K, et al. Factors affecting the prognosis of patients with esophageal cancer undergoing salvage surgery after definitive chemoradiotherapy. J Surg Oncol. 2006;93:422–8.

    Article  PubMed  Google Scholar 

  15. de Manzoni G, Pedrazzani C, Pasini F, et al. Chemoradiotherapy followed by surgery for squamous cell carcinoma of the thoracic esophagus with clinical evidence of adjacent organ invasion. J Surg Oncol. 2007;95:261–6.

    Article  PubMed  Google Scholar 

  16. Kawasaki S, Sato H, Tsubosa Y, et al. A case of recurrence of cervical esophageal cancer after definitive chemoradiotherapy underwent photodynamic therapy and cervical lymph node dissection. Jpn J Gastroenterol Surg. 2010;43:27–32.

    Article  Google Scholar 

  17. Udagawa H, Ueno M, Shinohara H, et al. The importance of grouping of lymph node stations and rationale of three-field lymphoadenectomy for thoracic esophageal cancer. J Surg Oncol. 2012;106:742–7.

    Article  PubMed  Google Scholar 

  18. Ohkura Y, Shindoh J, Ueno M, et al. Comparison of outcome of esophagectomy versus nonsurgical treatment for resectable esophageal cancer with clinical complete response to neoadjuvant therapy. Ann Surg Oncol. 2018 (Epub ahead of print).

  19. Ted CL, Jerry MS, Prashanth N, et al. Analysis of intensity-modulated radiation therapy (IMRT), proton and 3D conformal radiotherapy (3D-CRT) for reducing perioperative cardiopulmonary complications in esophageal cancer patients. Cancers. 2014;6:2356–68.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan

    Yu Ohkura MD, Masaki Ueno MD, PhD & Harushi Udagawa MD, PhD

  2. Okinaka Memorial Institute for Medical Research, Tokyo, Japan

    Yu Ohkura MD, Masaki Ueno MD, PhD, Toshiro Iizuka MD, PhD & Harushi Udagawa MD, PhD

  3. Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan

    Toshiro Iizuka MD, PhD

Authors
  1. Yu Ohkura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masaki Ueno MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshiro Iizuka MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harushi Udagawa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yu Ohkura MD.

Ethics declarations

Disclosure

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ohkura, Y., Ueno, M., Iizuka, T. et al. Prognostic Factors and Appropriate Lymph Node Dissection in Salvage Esophagectomy for Locally Advanced T4 Esophageal Cancer. Ann Surg Oncol 26, 209–216 (2019). https://doi.org/10.1245/s10434-018-7074-5

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-018-7074-5

Keywords

Search

Navigation