T4 esophageal cancer treated with radical resection

Abstract Circumferential resection margins (CRM) of an esophagectomy specimen for oesophageal cancer is a key prognostic factor of overall survival (OS). This retrospective study aims to compare OS of post-esophagectomy patients with CRM of >1 mm (R0) and < 1 mm (R1) with further subgroup analysis of locally advanced T3R0 vs T3R1 resection. Methods A total of 110 esophagectomies conducted between 2010 and 2020 were analysed. We recorded R stage based on pathological CRM >1 mm (R0) or < 1 mm (R1). OS was calculated from the day of surgery to day of death or otherwise censored. All patients underwent multimodal therapy including chemotherapy and similar pre-surgical and post-surgical management. 58 of these patients with pT3 stage esophageal cancer (EC) were selected and compared. Statistical analysis was carried out using SPSS. Results Of 110 patients, 78 (71.5%) patients had a R0 resection. Mean OS in R0 resections was 73 months (6 years) compared to 25.2 months (2 years) in R1 resection (p = 0.001). 58 of the 110 patients were pathological stage T3(pT3) despite downstaging with chemotherapy showing the burden of advanced disease. In patients with stage pT3 (n = 58), 32 patients were R0 resections, and 26 patients had R1 resections. Mean OS in T3R0 resections was 51.5 months compared to 28.5 months in T3R1 resection. OS comparison is significant (p = 0.011). Conclusion This study emphasizes the importance of clear CRM in all patients and especially in locally advanced pT3/T4a esophageal cancer in achieving long term survival. Techniques used to ensure a clear CRM such multimodality therapy combined with surgical radical resection concepts such as mesoesophagectomy should be employed.

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Treatment and clinical outcome of clinical T4 esophageal cancer: A systematic review

Annals of Gastroenterological Surgery ◽

10.1002/ags3.12222 ◽

2018 ◽

Vol 3 (2) ◽

pp. 169-180 ◽

Cited By ~ 5

Author(s):

Tomoki Makino ◽

Makoto Yamasaki ◽

Koji Tanaka ◽

Yasuhiro Miyazaki ◽

Tsuyoshi Takahashi ◽

...

Keyword(s):

Systematic Review ◽

Esophageal Cancer ◽

Clinical Outcome ◽

T4 Esophageal Cancer

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Definitive chemoradiotherapy with simultaneous integrated boost of radiotherapy dose for T4 esophageal cancer—will it stand for a standard treatment?

Journal of Thoracic Disease ◽

10.21037/jtd.2019.12.59 ◽

2019 ◽

Vol 11 (12) ◽

pp. 5682-5684

Author(s):

Satoru Matsuda ◽

Shuhei Mayanagi ◽

Tomoyuki Irino ◽

Hirofumi Kawakubo ◽

Yuko Kitagawa

Keyword(s):

Esophageal Cancer ◽

Standard Treatment ◽

Simultaneous Integrated Boost ◽

Definitive Chemoradiotherapy ◽

Integrated Boost ◽

T4 Esophageal Cancer ◽

Radiotherapy Dose

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Thoracic Endovascular Aortic Repair of Esophageal Cancer-Associated Aortoesophageal Fistula: A Case Report and Literature Review

Case Reports in Oncological Medicine ◽

10.1155/2018/9851397 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Akiko Sasaki ◽

Hideto Egashira ◽

Shinnosuke Tokoro ◽

Chikamasa Ichita ◽

Satoshi Takizawa ◽

...

Keyword(s):

Esophageal Cancer ◽

Stent Graft ◽

Postoperative Management ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Stent Insertion ◽

Aortoesophageal Fistula ◽

Bridge To Surgery ◽

Aortic Repair ◽

T4 Esophageal Cancer

Background. Thoracic endovascular aortic repair of an aortoesophageal fistula is an effective emergency treatment for patients with T4-esophageal cancer, as it prevents sudden death, and is a bridge to surgery. However, the course of unresectable malignant aortoesophageal fistula treated with thoracic endovascular aortic repair alone is not well-known. Case Presentation. We report a 67-year-old Japanese man with T4-esophageal cancer who experienced a chemoradiation-induced aortoesophageal fistula and was rescued with thoracic endovascular aortic repair. He recovered after the procedure and survived for 4 additional months with management of a mycotic aneurysm and secondary aortoesophageal fistula with the exposure of the stent graft into the esophagus. Thoracic endovascular aortic repair of aortoesophageal fistula with T4-esophageal cancer extended life for nearly an average of 4 months in the reported cases. As a postoperative complication, the exposure of the stent graft into the esophagus is rare but life-threatening; the esophageal stent insertion was effective. Conclusions. With postoperative management advances, thoracic endovascular aortic repair can improve survival and increase the quality of life of patients with T4-esophageal cancer.

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