Long-Term Survival Outcomes and Comparison of Different Treatment Modalities for Stage I-III Cervical Esophageal Carcinoma

Purpose: To investigate the survival outcomes, prognostic factors and treatment modalities of stage I-III cervical esophageal carcinoma (CEC) patients using data from the Surveillance, Epidemiology, and End Results (SEER) database from the period 2004–2016.Methods: Patients with a histopathologic diagnosis of CEC were included. The primary endpoint was overall survival (OS). Univariate and multivariate analyses of OS were performed using Cox proportional hazards models, and OS was compared using the Kaplan-Meier method and log-rank test.Results: A total of 347 patients in the SEER database were enrolled. The median OS was 14.0 months, with a 5-year OS rate of 20.9%. The parameters that were found to significantly correlate with OS in the multivariate analysis were age at diagnosis [P < 0.001, hazard ratio (HR) = 1.832], sex [P < 0.001, HR= 1.867], histology [P = 0.001, HR = 0.366], surgery at the primary site [P = 0.021, HR = 0.553], radiotherapy (RT, P = 0.017, HR = 0.637) and chemotherapy (CT, P < 0.001, HR = 0.444). Comparison among the three treatment modalities demonstrated that a triple therapy regimen consisting of surgery, RT and CT was associated with a longer survival time than the other two treatment modalities before and after propensity score matching (PSM). However, triple therapy showed no significant survival benefit over double therapy (P = 0.496 before PSM and P = 0.184 after PSM).Conclusions: The survival of patients with CEC remains poor. Surgery, RT and CT were all strongly correlated with OS. We recommend a triple therapy regimen for select CEC patients based on the findings of the current study, although this recommendation should be further confirmed by prospective studies with large sample sizes.

67 STRATEGY FOR DEFINITIVE TREATMENT AND PRESERVING QUALITY OF LIFE IN UPPER CERVICAL ESOPHAGEAL CARCINOMA

In radical surgery for upper cervical esophageal carcinoma, questions such as whether the larynx should be preserved depending on the distance from the esophageal orifice to the tumor margin and risk of aspiration during swallowing arise. We report the clinical outcomes of our strategy for upper cervical esophageal carcinoma based on the goals of curability and larynx preservation. Methods At our institution, resectable upper cervical esophageal carcinoma in which the tumor margin on the oral side is within 3 cm of the esophageal orifice is treated with chemoradiotherapy followed by larynx-preserving esophagectomy. The reason for initially using chemoradiotherapy is to make the surgical margin on the oral side completely negative and as distal as possible for definitive treatment and to improve quality of life (QOL). From 2016 to 2019, there were 24 patients who were diagnosed with upper cervical esophageal carcinoma within 3 cm of the esophageal orifice and received chemoradiotherapy and larynx-preserving esophagectomy. Results All patients were eligible for chemoradiotherapy and larynx-preserving esophagectomy. Pathologically, all surgical margins on the oral side were negative and all operations were curative. In particular, 6 patients with a tumor margin within 1 cm of the esophageal orifice underwent successful curative, larynx-preserving esophagectomy with the following additional techniques: incision of the cricopharyngeus muscle, lifting of the trachea and larynx, and rotation of the larynx to the left. Regarding surgical complications, 4 patients had temporary recurrent nerve paralysis with aspiration pneumonia and 1 patient had minor anastomotic leakage. Conclusion The combination of chemoradiotherapy and esophagectomy with a larynx-preserving technique is a useful treatment strategy for upper cervical esophageal carcinoma in terms of both definitive treatment and QOL.

PS01.143: ANALYSIS OF THORACOSCOPE, LAPAROSCOPY COMBINED WITH TOTAL LARYNGECTOMY IN TREATMENT OF CERVICAL ESOPHAGEAL CARCINOMA OPERATION

Background To investigate the feasibility and efficacy of cervical esophageal carcinoma operation through thoracoscope, laparoscopy combined with total laryngectomy. Methods Retrospect and analyze the data of 53 patients with cervical esophageal carcinoma undergone surgical treatment in Department of Thoracic Surgery, First Hospital Affiliated to Xiamen University from May.2010 to May.2017. Operation procedure: separate esophagus under thoracoscope, rebuild gastric tube, resect full throat, perform tracheostoma permanently, apply gastric-pharyngeal anastomosis. Results Thoracic operation time was 50 ∼ 65 min, average 57 min; abdominal operation time was 46 ∼ 62 min, average 54 min; neck surgery time was 117 ∼ 137 min, average 125 min. The amount of intraoperative bleeding was 78∼ 260 ml, average 180 ml. The postoperative hospital stay was 7 ∼ 15d, average 10d. All the cases were squamous cell carcinoma, 6 cases of high differentiated squamous cell carcinoma, 31 cases of squamous cell carcinoma, 10 cases of middle-low differentiated squamous cell carcinoma, 6 cases of low differentiated squamous cell carcinoma. All the resection edges had been proved no residual tumor left by pathological examination. In 53 cases, lymph node metastasis occurred in 48 cases, anastomotic fistula occurred in 1 cases, 2 cases of pulmonary infection, 1 cases of gastric emptying and 1 case anastomotic stenosis happed, and there is no death case. All the patients were followed up from 1 months to 5 years, the 1st, 3rd, 5th year survival rate was 83.8%, 51.2% and 23.1% respectively. Conclusion Cervical esophageal carcinoma operation treatment should be taken actively, Gastric pharyngeal anastomosis is an effective mean to treat cervical esophageal carcinoma. Disclosure All authors have declared no conflicts of interest.