Is esophagectomy following upfront chemoradiotherapy safe and necessary?
J. M. Kane 3rd, L. L. Shears, U. Ribeiro, M. R. Clark, M. Peterson, R. J. Landreneau and M. C. Posner
Department of Surgery, University of Pittsburgh, USA.
OBJECTIVE: To examine the safety and necessity of esophagectomy following
upfront chemoradiotherapy (CRT) in patients with potentially resectable
esophageal cancer. DESIGN: Cohort analytic study during a 4-year period.
SETTING: Tertiary referral center. PATIENTS: Thirty-seven patients who
completed CRT and underwent esophagectomy as compared with 30 patients who
underwent esophagectomy alone without pretreatment during the same period.
MAIN OUTCOME MEASURES: Resection-related events, perioperative morbidity
and mortality, response to CRT, site of residual disease following CRT, and
survival of partial responders. RESULTS: Patients receiving CRT followed by
esophagectomy were similar to patients who underwent esophagectomy alone
for operative characteristics, postoperative course, and perioperative
morbidity and mortality. Of the 33 patients who achieved an objective
response to CRT, 23 had residual tumor in the resection specimen. Of the 18
patients alive with no evidence of disease at a median follow-up of 30
months, 50% had residual tumor following CRT. CONCLUSIONS: Upfront CRT did
not adversely affect resection-related outcome and may facilitate resection
by downstaging disease. A considerable number of patients had prolonged
survival after esophageal resection despite having residual tumor present
following treatment with upfront CRT. Therefore, esophagectomy following
upfront CRT can improve locoregional control of disease and should remain a
critical component of any multimodality regimen.
