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Outcomes Associated with Surgery for T4 Esophageal Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

T4 esophageal cancer often portends a dismal prognosis even after surgical resection. Historical incomplete resections and poor survival rates often make surgery palliative rather than curative.

Methods

Using a comprehensive esophageal cancer database, we identified patients who underwent an esophagectomy for T4 tumors between 1994 and 2011. Neoadjuvant treatment (NT) and pathologic response variables were recorded, and response was denoted as complete response (pCR), partial response (pPR), and nonresponse (NR). Clinical and pathologic data were compared. Survival was calculated using Kaplan–Meier curves with log-rank tests for significance.

Results

We identified 45 patients with T4 tumors all who underwent NT. The median age was 60 years (range, 31–79 years) with a median follow-up of 27 months (range, 0–122 months). There were 19 pCR (42 %), 22 pPR (49 %), and 4 NR (9 %). R0 resections were accomplished in 43 (96 %). There were 18 recurrences (40 %) with a median time to recurrence of 13.5 months (2.2–71 months). In this group pCR represented 7 (38.9 %), whereas pPR and NR represented 10 (55.5 %), and 1 (5.5 %) respectively. The overall and disease-free survival for all patients with T4 tumors were 35 and 36 %, respectively. Patients achieving a pCR had a 5 year overall and disease-free survival of 53 and 54 %, compared with pPR 23 and 28 %, while there were no 5 year survivors in the NR cohort.

Conclusion

We have demonstrated that neoadjuvant therapy and downstaging of T4 tumors leads to increased R0 resections and improvements in overall and disease-free survival.

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Authors and Affiliations

  1. Program of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Jose M. Pimiento MD, Jill Weber MPH, Khaldoun Almhanna MD, Shivakumar Vignesh MD, Richard C. Karl MD, FACS & Kenneth L. Meredith MD, FACS

  2. Program of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Sarah E. Hoffe MD & Ravi Shridhar MD, PhD

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  1. Jose M. Pimiento MD
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  2. Jill Weber MPH
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  3. Sarah E. Hoffe MD
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  4. Ravi Shridhar MD, PhD
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  5. Khaldoun Almhanna MD
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  6. Shivakumar Vignesh MD
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  8. Kenneth L. Meredith MD, FACS
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Correspondence to Kenneth L. Meredith MD, FACS.

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Pimiento, J.M., Weber, J., Hoffe, S.E. et al. Outcomes Associated with Surgery for T4 Esophageal Cancer. Ann Surg Oncol 20, 2706–2712 (2013). https://doi.org/10.1245/s10434-013-2885-x

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  • DOI: https://doi.org/10.1245/s10434-013-2885-x

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