Surgical treatment for locally advanced (T4) squamous cell carcinoma of the thoracic esophagus |
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Authors: | Tachibana Mitsuo Dhar Dipok Kumar Kinugasa Shoichi Yoshimura Hiroshi Shibakita Muneaki Ohno Satoshi Ueda Shuhei Fujii Toshiyuki Kohno Hitoshi Nagasue Naofumi |
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Institution: | (1) Second Department of Surgery, Shimane Medical University, Enya-cho 89-1, Izumo 693-8501, Shimane, Japan, |
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Abstract: | It is still difficult to decide on the treatment modalities for advanced esophageal carcinoma when the prognostic factors
of T4 esophageal cancer are not fully understood. In this article, we report that among 71 patients with T4 thoracic esophageal
cancer, 49 underwent esophagectomy, 9 had curative resection (R0 group), and 40 had palliative resection (R1/2 group). A total
of 22 patients had palliative treatments: bypass in 5 (bypass group), gastrostomy or jejunostomy in 6 (stoma group), and radiochemotherapy
alone in 11 (nonoperation group). Clinicopathologic characteristics were retrospectively investigated. Treatment-related deaths
occurred in 7 (10%): none in R0, 3 (8%) in R1/2, 3 (60%) in bypass, and 1 (17%) in stoma group. Swallowing was improved in
50 (70%) patients: 9 (100%) in R0, 30 (75%) in R1/2, 1 (20%) in bypass, 3 (50%) in stoma, and 7 (64%) in the nonoperation
group. One-, two-, and three-year overall survival rates were 56%, 22%, and 22% in the R0 group and 35%, 19% and 6% in the
R1/2 group, respectively (p = 0.19). In the bypass, stoma, and nonoperation groups, none survived 1.6 years. The factors influencing the survival rate
of the 49 patients undergoing esophagectomy were grade of lymph node metastasis, amount of perioperative blood transfusion,
lymph vessel, and blood vessel invasion. Among these, independent prognostic factors for survival were amount of blood transfusion
(≤6 units vs. ≥7 units, p < 0.0001) and grade of lymph node metastasis {none- or peritumoral lymph nodes adjacent to the main tumor or at a nearby
location (<3 cm) from the tumor] metastasis vs. more distant metastasis lymph nodes at a distant location (> 3 cm)], p = 0.016}. Bypass and stoma operation neither prolonged the survival nor improved the difficulty of swallowing compared with
radiochemotherapy alone. Esophagectomy can achieve the best improvement of swallowing and the longest survival with an acceptable
mortality rate. Esophageal carcinoma patients with T4 disease and distinct metastasis in the lymph nodes at a distant location
(>3 cm) from the primary tumor may not benefit from an esophageal resection. |
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Keywords: | Esophageal cancer T4 tumor Locally advanced tumor Long-term-result Clinicopathologic features Deglutition Deglutition disorders |
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