Download Esophagectomy

Sachiko Yamamoto MD, Ryu Ishihara MD, Masaaki Motoor
i MD, Yoshifumi Kawaguchi MD, Noriya Uedo MD, Yoji Tak
euchi MD, Koji Higashino MD, Masahiko Yano MD, Satoak
i Nakamura MD and Hiroyasu Iishi MD
Am J Gastroenterol 2011; 106:1048–1054
R1 Jong Kyu Byun/ Prof. Jae Young Jang
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Esophageal cancer is the sixth most common causes of cancerrelated mortality worldwide.
Squamous cell carcinoma remains the most common tumor type.
Stage I (UICC-TNM classification: T1N0M0) esophageal cancer,
defined as mucosal or submucosal cancer without lymph node or d
istant metastasis
Esophagectomy has been the mainstay of treatment for esophageal
cancer
Esophagectomy is associated with significant mortality and substan
tial morbidity.
Chemoradiotherapy (CRT) has been proposed as an alternative to
esophagectomy, because of its favorable survival rate and mild
toxicity
To compare the overall survival of two cohorts of patients with
clinical stage I esophageal squamous cell carcinoma treated with
either CRT or conventional esophagectomy.
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Patient population and staging system
Retrospective cohort study of patients with clinical
stage I esophageal squamous cell carcinoma,
untreatable by endoscopic therapy.
 Submucosal cancers or widespread cancers larger
than 5 cm or with a circumferential spread more
than 2/3 were referred for CRT or esophagectomy
 Diagnostic tool
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 T-category - endoscopy,
 N-category - CT.
endosonography
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Chemoradiotherapy
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A total of 53 patients were treated with cisplatin and
fluorouracil- based chemotherapy
Concurrent radiotherapy using 10-MV X-rays was
delivered at a dose of 2 Gy per day, five days a week,
for a total dose of 60 Gy in 30 fractions.
Esophagectomy
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Two- or three-field lymphadenectomy via rightthoracotomy
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Follow-up evaluation and pattern of recurrence
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CRT
 1–2 months after CRT and then every 3–6 months for the
first 2 years, and every 6 months thereafter.
 PEx , blood test, endoscopy of the esophagus with iodine
staining, and CT scan of the neck, chest, and abdomen.
Esophagectomy
 every 6 months for 5 years.
 PEx, blood test, and CT scan of the neck, chest, and
abdomen. Endoscopy was performed annually.
Local recurrence included the recurrence or progression of
the primary tumor, and metachronous esophageal cancer.
Non-local recurrence included recurrence in the lymph
nodes or any site beyond the primary tumor.
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Statistical analysis
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overall survival,
 Start : Day 1 of CRT or the date of esophagectomy
 End : The date of death or 31 March 2009, whichever
occurred first.
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progression-free survival (PFS)
 Start : Day 1 of CRT or the date of esophagectomy,
 End : The date of recurrence or death, or 31 March 2009,
whichever occurred first.
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For all analyses a two-sided P value of <0.05 was
considered statistically significant.
SURG group
CRT group
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Survival
 Follow
up
 CRT group 100 % (54 patients)
 SURG group 99 % (115 of 116 patients )
 Observation
period
 CRT group
 SURG group
30 (4–77) months
67 (10–171) months
 Death
 CRT group
 SURG group
6 (3 deaths due to esophageal ca.)
30 (20 deaths due to esophageal ca.)
Overall survival rates
SURG
CRT
1- year
97.4%
98.1%
3-year
85.5%
88.7%
PFS (non-local) rates
SURG
CRT
1- year
93.9%
90.5%
3-year
81.9%
83.5%
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The overall survival rate
Locally recurrent carcinoma was endoscopically treatable
in most patients, with no effect on overall survival.
CRT seems to be a viable alternative to esophagectomy in
patients with clinical stage I esophageal cancer.