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Surgery Is an Essential Component of Multimodality Therapy for Patients with Locally Advanced Esophageal Adenocarcinoma

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Experience with neoadjuvant chemoradiation (CXRT) has raised questions regarding the additional benefit of surgery after locally advanced esophageal adenocarcinoma patients achieve a clinical response to CXRT. We sought to quantify the value of surgery by comparing the overall (OS) and disease-free survival (DFS) of trimodality-eligible patients treated with definitive CXRT vs. CXRT followed by esophagectomy.

Methods

We identified 143 clinical stage III esophageal adenocarcinoma patients that were eligible for trimodality therapy. All patients successfully completed neoadjuvant CXRT and were considered appropriate candidates for resection. Patients that were medically inoperable were excluded. Cox regression models were used to identify significant predictors of survival.

Results

Among the 143 patients eligible for surgery after completing CXRT, 114 underwent resection and 29 did not. Poorly differentiated tumors (HR = 2.041, 95% CI = 1.235–3.373) and surgical resection (HR = 0.504, 95% CI = 0.283–0.899) were the only independent predictors of OS. Patients treated with surgery had a 50 and 54 % risk reduction in overall and cancer-specific mortality, respectively. Median OS (41.2 vs. 20.3 months, p = 0.012) and DFS (21.5 vs. 11.4 months, p = 0.007) were significantly improved with the addition of surgery compared to definitive CXRT.

Conclusions

Surgery provides a significant survival benefit to trimodality-eligible esophageal adenocarcinoma patients with locally advanced disease.

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Acknowledgments

The authors would like to thank the generous support of the Stuart & Flora Mason Family Foundation and the Edwards Family Esophageal Research Fund.

Conflicts of Interest

None.

Financial Disclosures

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Author information

Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Caitlin C. Murphy, Arlene M. Correa, Stephen G. Swisher & Wayne L. Hofstetter

  2. Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Jaffer A. Ajani

  3. Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Ritsuko U. Komaki & James W. Welsh

  4. The University of Texas School of Public Health, Houston, TX, USA

    Caitlin C. Murphy

  5. 1515 Holcombe Blvd., Unit 445, Houston, TX, 77030, USA

    Wayne L. Hofstetter

Authors
  1. Caitlin C. Murphy
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  2. Arlene M. Correa
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  3. Jaffer A. Ajani
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  4. Ritsuko U. Komaki
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  5. James W. Welsh
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  6. Stephen G. Swisher
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  7. Wayne L. Hofstetter
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Corresponding author

Correspondence to Wayne L. Hofstetter.

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Fig. 6

Median overall survival of trimodality-eligible patients with locally advanced esophageal adenocarcinoma with poorly differentiated tumors treated with chemoradiation followed by surgery compared to definitive chemoradiation (n = 91) (JPEG 96 kb)

High resolution image (EPS 504 mb)

Fig. 7

Median overall survival of trimodality-eligible patients with locally advanced esophageal adenocarcinoma with post-treatment SUV ≥ 8.75 treated with chemoradiation followed by surgery compared to definitive chemoradiation (n = 12) (JPEG 77 kb)

High resolution image (EPS 504 mb)

Fig. 8

Median overall survival of trimodality-eligible patients with locally advanced esophageal adenocarcinoma with post-treatment SUV = 3.45 to <8.75 treated with chemoradiation followed by surgery compared to definitive chemoradiation (n = 82) (JPEG 92 kb)

High resolution image (EPS 504 mb)

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Murphy, C.C., Correa, A.M., Ajani, J.A. et al. Surgery Is an Essential Component of Multimodality Therapy for Patients with Locally Advanced Esophageal Adenocarcinoma. J Gastrointest Surg 17, 1359–1369 (2013). https://doi.org/10.1007/s11605-013-2223-4

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  • DOI: https://doi.org/10.1007/s11605-013-2223-4

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