Advertisement

Annals of Surgical Oncology

, Volume 25, Issue 8, pp 2428–2433 | Cite as

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

  • Yu Ohkura
  • Junichi Shindoh
  • Masaki Ueno
  • Toshiro Iizuka
  • Harushi Udagawa
Gastrointestinal Oncology

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.

Notes

Author contributions

YO, JS, MU and HU designed the study, wrote the manuscript, revised it critically for important intellectual content, and gave final approval for the content; YO, JS, MU, TI, and HU created study materials or recruited patients.

Conflict of interests

There are no conflicts of interest.

References

  1. 1.
    Allum WH, Stenning SP, Bancewicz J, et al. Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol. 27:5062-7.CrossRefGoogle Scholar
  2. 2.
    Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68-74.CrossRefPubMedGoogle Scholar
  3. 3.
    Nakamura K, Kato K, Igaki H, et al. Three-arm phase III trial comparing cisplatin plus 5-FU (CF) versus docetaxel, cisplatin plus 5-FU (DCF) versus radiotherapy with CF (CF-RT) as preoperative therapy for locally advanced esophageal cancer (JCOG1109, NExT study). Jpn J Clin Oncol. 2013;43:752-5.CrossRefPubMedGoogle Scholar
  4. 4.
    Oppedijk V, van der Gaast A, van Lanschot JJ et al. Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS Trials. J Clin Oncol. 2014;32:385-91.CrossRefPubMedGoogle Scholar
  5. 5.
    van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366:2074-84.CrossRefPubMedGoogle Scholar
  6. 6.
    Bedenne L, Michel P, Bouché O, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007;25:1160-8.CrossRefPubMedGoogle Scholar
  7. 7.
    Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol. 2005;23:2310-7.CrossRefPubMedGoogle Scholar
  8. 8.
    Sobin LH, Gospodarowicz MK, Wittekind C, eds. International Union Against Cancer. Oesophagus including oesophagogastric junction. “TNM classification of malignant tumours.” West Sussex, UK: Wiley-Blackwell; 2009:66-72.Google Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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.CrossRefPubMedGoogle Scholar
  11. 11.
    Japanese Esophageal Society. Japanese Classification of Esophageal Cancer, 11th edn. Parts II and III. Esophagus 2017;14:37-65.Google Scholar
  12. 12.
    Piessen G, Messager M, Mirabel X, et al. Is there a role for surgery for patients with a complete clinical response after chemoradiation for esophageal cancer? An intention-to-treat case-control study. Ann Surg. 2013;258:793-9.PubMedGoogle Scholar
  13. 13.
    Shi-Liang L, Mian X, Hong Y, et al. Is there a correlation between clinical complete response and pathological complete response after neoadjuvant chemoradiotherapy for esophageal squamous cell cancer? Ann Surg Oncol. 2016;23:273-81.CrossRefGoogle Scholar
  14. 14.
    Castoro C, Scarpa M, Cagol M, et al. Complete clinical response after neoadjuvant chemoradiotherapy for squamous cell cancer of the thoracic oesophagus: is surgery always necessary? J Gastrointest Surg. 2013;17:1375-81.CrossRefPubMedGoogle Scholar
  15. 15.
    Cheedella NK, Suzuki A, Xiao L, et al. Association between clinical complete response and pathological complete response after preoperative chemoradiation in patients with gastroesophageal cancer: analysis in a large cohort. Ann Oncol. 2013;24:1262-6.CrossRefPubMedGoogle Scholar
  16. 16.
    Inoue J, Ono R, Makiura D, et al. Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer. Dis Esophagus. 2013;26(1):68-74.CrossRefPubMedGoogle Scholar
  17. 17.
    Wang SL, Liao ZX, Vaporciyan AA, et al. Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int J Radiat Oncol Biol Phys. 2006;64:692–9.CrossRefPubMedGoogle Scholar
  18. 18.
    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.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Yu Ohkura
    • 1
  • Junichi Shindoh
    • 1
  • Masaki Ueno
    • 1
  • Toshiro Iizuka
    • 2
  • Harushi Udagawa
    • 1
  1. 1.Department of Gastroenterological SurgeryToranomon Hospital and Okinaka Memorial Institute for Medical ResearchTokyoJapan
  2. 2.Department of GastroenterologyToranomon Hospital and Okinaka Memorial Institute for Medical ResearchTokyoJapan

Personalised recommendations