Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec;124(8):1296-1305.
doi: 10.1002/jso.26648. Epub 2021 Aug 17.

The role of surgery after prolonged primary chemotherapy for advanced oesophageal adenocarcinoma

Mohamed S Aboul-Enein  1   2 , William Knight  1 , Wahyu Wulaningsih  1 , Daniel M Foley  1 , Dionysios Dellaportas  1 , Janine Zylstra  1   2   3 , Cara R Baker  1   3   4 , Mark Kelly  1   3   4 , Elizabeth Smyth  5 , Jesper Lagergren  1   3   4 , Nick Maisey  6 , William H Allum  7 , James A Gossage  1   2   3 , David Cunningham  5   8 , Andrew R Davies  1   3   4 ; Guy's and St Thomas' Oesophago-gastric Research Group
Affiliations

The role of surgery after prolonged primary chemotherapy for advanced oesophageal adenocarcinoma

Mohamed S Aboul-Enein et al. J Surg Oncol. 2021 Dec.

Abstract

Background: Most patients presenting with oesophageal cancer do so with advanced disease not suitable for surgery. However, there are examples of encouraging survival following surgery in highly selected patients who respond well to chemotherapy.

Methods: This was a retrospective cohort study of patients who presented with advanced but nonvisceral metastatic oesophageal cancer. Consecutive patients on a prolonged primary chemotherapy pathway who underwent surgical resection following a favourable response to chemotherapy were included. Survival and recurrence rates were analysed using Cox regression, providing hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: A total of 57 patients included in the cohort operated between 2007 and 2015, the overall median survival was 44 months and the 5-year survival was 42%. Prechemotherapy cN0/cN1 (HR: 0.27, 95% CI: 0.12-0.62) conferred an independent survival advantage compared to cN2 and cN3 disease. Poor differentiation (HR: 2.46, 95% CI: 1.11-5.42), R1 resection (HR: 2.43, 95% CI: 1.14-5.19) and advanced nodal status (HR: 3.28, 95% CI: 1.44-7.47) predicted worse survival on univariable analysis. Poor differentiation (HR: 3.93, 95% CI: 1.62-9.56) was independently associated with poor survival when adjusted for other variables.

Conclusion: Patients who present with advanced inoperable oesophageal cancer who have a favourable response to chemotherapy represent a limited group of patients who may benefit from surgery.

Keywords: chemotherapy; oesophageal surgery; oesophegeal cancer; prognosis.

PubMed Disclaimer

References

REFERENCES

    1. Mönig S, van Hootegem S, Chevallay M, Wijnhoven BPL. The role of surgery in advanced disease for esophageal and junctional cancer. Best Pract Res Clin Gastroenterol. 2018;36-37:91-96. https://doi.org/10.1016/j.bpg.2018.11.002
    1. Allum WH, Blazeby JM, Griffin SM, et al. Guidelines for the management of oesophageal and gastric cancer. Gut. 2011;60(11):1449-1472. https://doi.org/10.1136/gut.2010.228254
    1. Lagergren J, Smyth E, Cunningham D, Lagergren P. Oesophageal cancer. Lancet. 2017;390:2383-2396.
    1. Huddy JR, Thomas RL, Worthington TR, Karanjia ND. Liver metastases from esophageal carcinoma: is there a role for surgical resection? Dis Esophagus. 2015;28(5):483-487. https://doi.org/10.1111/dote.12233
    1. Yamamoto T, Tachibana M, Kinugasa S, Yoshimura H, Nagasue N. Esophagectomy and hepatic arterial chemotherapy following hepatic resection for esophagel cancer with liver metastasis. J Gastroenterol. 2001;36(8):560-563. https://doi.org/10.1007/s005350170060

MeSH terms

Supplementary concepts

LinkOut - more resources