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World Journal of Surgery

, Volume 39, Issue 2, pp 424–432 | Cite as

Esophageal Cancer Management: Preoperative CA19.9 and CEA Serum Levels May Identify Occult Advanced Adenocarcinoma

  • Marco ScarpaEmail author
  • Giulia Noaro
  • Luca Saadeh
  • Francesco Cavallin
  • Matteo Cagol
  • Rita Alfieri
  • Mario Plebani
  • Carlo Castoro
Original Scientific Report

Abstract

Background

Esophagectomy is contraindicated in case of advanced cancer (i.e., carcinomatosis, distant metastasis, and invasion of other organs). In some cases, preoperative imaging may fail to identify advanced neoplasm and esophagectomy is inappropriately planned. The aim of the study was to identify preoperative biomarkers of occult advanced disease that force surgeons to abort the planned esophagectomy.

Methods

From 2008 to 2014, 244 consecutive patients were taken to the operative room to have esophagectomy for cancer in our department. All of them had blood test at admission and their preoperative biomarker data were retrieved. Their medical history was collected and the intraoperative findings and outcome were recorded. Non parametric tests, multiple regression analysis, and ROC curves analysis were performed.

Results

In our study group, 14 (5.7 %) patients, scheduled for esophagectomy, were discovered to have occult advanced disease at laparotomy/laparoscopy or at thoracotomy. Six of them had peritoneal carcinomatosis, three had advanced tumor invading other organs, three had small liver metastasis, and two pleural carcinomatosis. In all these cases, esophagectomy was aborted and a feeding jejunostomy was placed. In patients with unresectable esophageal cancer, CA19.9 and CEA serum levels were significantly higher than patients who could have esophagectomy (p < 0.001 and p = 0.003, respectively). CA19.9 and CEA resulted to be accurate biomarkers of occult advanced disease (AUC = 85 %, p < 0.001 and AUC = 73 %, p = 0.002, respectively).

Conclusions

Preoperative CEA and CA19.9 serum levels should be taken in consideration when evaluating patients candidate to esophagectomy for esophageal cancer to prevent inappropriate laparotomy or thoracotomy. If any doubt arises minimally invasive exploration is warranted.

Keywords

Pancreatic Cancer Esophageal Cancer Esophageal Squamous Cell Carcinoma Peritoneal Carcinomatosis Esophageal Adenocarcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Marco Scarpa
    • 1
    Email author
  • Giulia Noaro
    • 1
  • Luca Saadeh
    • 1
  • Francesco Cavallin
    • 1
  • Matteo Cagol
    • 1
  • Rita Alfieri
    • 1
  • Mario Plebani
    • 2
  • Carlo Castoro
    • 1
  1. 1.Surgical Oncology UnitVeneto Institute of Oncology (IOV-IRCCS)PaduaItaly
  2. 2.Department of Laboratory MedicineUniversity of PadovaPaduaItaly

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