Is there room for improvement in esophageal cancer surgery? Results of a prospective protocol for individualization of surgical treatment

• Published in: Esophagus : official journal of the Japan Esophageal Society 2014-09, Vol.11 (4), p.258-266
• Main Authors: Theodorou, Dimitrios, Doulami, Georgia, Memos, Nikolaos, Kokoroskos, Nikolaos, Vrakopoulou, Gavriella-Zoi, Triantafyllou, Stamatina, Kleidi, Eleftheria, Katsaragakis, Stylianos, Zografos, George
• Format: Article
• Language: English
• Subjects: Esophageal cancer; Esophagus; Gastroenterology; Medicine; Medicine & Public Health; Original Article; Patients; Surgery; Surgical Oncology; Thoracic Surgery; Throat surgery
• ISSN: 1612-9059; 1612-9067
• DOI: 10.1007/s10388-014-0440-x

Background Despite improvements in multimodality approach , overall survival of esophageal cancer (EC) is still very low. Because of the rarity of the disease and the lack of large prospective studies, several controversies exist regarding the optimal type of surgery and the use of adjuvant and neoadjuvant therapy. Traditionally, the debate for the extent lymphadenectomy is between transhiatal esophagectomy with 1-field lymphadenectomy (THE-1FL) and transthoracic esophagectomy with 2-field lymphadenectomy (TTE-2FL). The purpose of this study is to evaluate the effect of optimal patient selection for submission to each procedure, on overall survival. Methods Patients with EC were prospectively enrolled in a database and a protocol of individualized surgical treatment of EC (PISTEC) was applied to patients with resectable disease. PISTEC is based on patient’s physical status and disease stage, with intent to select the appropriate surgical procedure for each patient. Results From 01/2006 to 12/2011, 61 patients with EC were individualized according to the PISTEC. Of them, 52.4 % were submitted to THE-1FL and 31.1 % to TTE-2FL. The 30-day mortality rate was 4.9 %. The 5-year overall survival rate was 54.9 % and recurrence was observed in 27.5 % of patients. The estimated 5-year overall survival of patients with stages 0, I, II, III and IV was 100, 100, 92.9, 45 and 0 %, respectively. Conclusion The algorithm proposed by the PISTEC aims at balancing perioperative risks with oncological benefit. When type of surgery is individualized, the outcomes regarding survival are favorable. This effect could probably be enhanced with the concurrent application of neoadjuvant treatment.