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Annals of Surgical Oncology

, Volume 22, Issue 6, pp 1866–1873 | Cite as

Comparison of Transthoracic Esophagectomy with Definitive Chemoradiotherapy as Initial Treatment for Patients with Esophageal Squamous Cell Carcinoma Who Could Tolerate Transthoracic Esophagectomy

  • Satoru Matsuda
  • Yasuhiro TsubosaEmail author
  • Masahiro Niihara
  • Hiroshi Sato
  • Katsushi Takebayashi
  • Keisuke Kawamorita
  • Keita Mori
  • Takahiro Tsushima
  • Tomoya Yokota
  • Hirofumi Ogawa
  • Yusuke Onozawa
  • Hirofumi Yasui
  • Hiroya Takeuchi
  • Yuko Kitagawa
Thoracic Oncology

Abstract

Background

The oncological outcomes of transthoracic esophagectomy (TTE) and definitive chemoradiotherapy (dCRT) as initial treatment in patients with esophageal squamous cell carcinoma (ESCC) who could tolerate TTE remains unclear.

Methods

Consecutive patients histologically diagnosed with stage I/II/III ESCC (excluding cT4 or cN3) or stage IV ESCC due to supraclavicular lymph node metastasis were eligible for inclusion in this retrospective study. To select patients who could tolerate TTE, respiratory function, Eastern Cooperative Oncology Group performance status, and preoperative complications were considered. Patient characteristics, recurrence-free survival (RFS), 3- and 5-year overall survival (OS), pattern of recurrence, and treatments after initial treatment failure were investigated.

Results

Overall, 112 patients were included in the TTE group and 65 were included in the dCRT group. No significant differences were observed in patient characteristics and clinical stage between the TTE and dCRT groups (stage I/II/III/IV of 29/27/46/10 in the TTE group and 23/15/20/7 in the dCRT group). The R0 resection rate was 87 % in the TTE group, and complete response rate was 68 % in the dCRT group. In intention-to-treat analysis, there was no significant difference in RFS. In contrast, 3-year OS of non-stage IA patients was significantly longer in the TTE group than the dCRT group (TTE 66.9 %; dCRT 49.8 %; p = 0.023). In non-stage IA patients, after initial treatment failure significantly more patients could undergo local treatment (radiotherapy or surgery in the TTE group; surgery or endoscopic resection or photodynamic therapy in the dCRT group) in the TTE group than the dCRT group (TTE 74 %; dCRT 40 %; p = 0.003).

Conclusions

In locally advanced ESCC patients who could tolerate TTE, TTE extended 3-year OS, which might have been encouraged by utilizing local treatment after initial treatment failure.

Keywords

Overall Survival Esophageal Cancer Esophageal Squamous Cell Carcinoma Endoscopic Resection Esophageal Squamous Cell Carcinoma Patient 
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.

Notes

Disclosure

Yuko Kitagawa has the following financial relationships to disclose: research funding from Kyowa Hakko Kirin Co., Ltd, Bristol-Myers Co., Ltd, Nippon Kayaku Co., Ltd, Pfizer Co., Ltd, and Yakult Honsha Co., Ltd.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Satoru Matsuda
    • 1
  • Yasuhiro Tsubosa
    • 1
    Email author
  • Masahiro Niihara
    • 1
  • Hiroshi Sato
    • 2
  • Katsushi Takebayashi
    • 1
  • Keisuke Kawamorita
    • 1
  • Keita Mori
    • 3
  • Takahiro Tsushima
    • 4
  • Tomoya Yokota
    • 4
  • Hirofumi Ogawa
    • 5
  • Yusuke Onozawa
    • 4
  • Hirofumi Yasui
    • 4
  • Hiroya Takeuchi
    • 6
  • Yuko Kitagawa
    • 6
  1. 1.Division of Esophageal SurgeryShizuoka Cancer Center HospitalShizuokaJapan
  2. 2.Division of Upper Gastrointestinal Tract, Department of Surgery, International Medical CenterSaitama UniversitySaitamaJapan
  3. 3.Clinical Trial Coordination OfficeShizuoka Cancer Center HospitalShizuokaJapan
  4. 4.Division of Gastrointestinal OncologyShizuoka Cancer Center HospitalShizuokaJapan
  5. 5.Division of Radiation OncologyShizuoka Cancer Center HospitalShizuokaJapan
  6. 6.Department of SurgeryKeio University School of MedicineTokyoJapan

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