International Session(Symposium)2(JSGS・JSGE・JGES)
Fri. November 3rd   14:00 - 17:00   Room 11: Portopia Hotel South Wing Topaz
Prognostic benefit of conversion surgery for unresectable thoracic esophageal cancer with invasion of other organs
Kohei Kanamori1, Akihito Kazuno1, Kazuo Koyanagi1
1Department of Gastroenterological Surgery, Tokai University School of Medicine
Chemoradiation therapy (CRT) and induction chemotherapy (ICT) have been applied for esophageal cancer invading aorta or trachea. Cancer free is considered an important factor related to prognosis.
We analyzed clinicopathological factors and prognosis in 85 patients with cT4b (JES 11th Ed.) thoracic esophageal cancer treated between 2009 and 2022.
Invading organs were trachea in 41 cases/left main bronchus in 29 cases/aorta in 29 cases. ICT was introduced as an initial treatment in 44 cases (CF20/DCF24) / CRT in 41 cases. In the ICT group, T4b disappeared in 28 patients. CR was achieved in 16 (39%) patients in the CRT group. Conversion surgery was indicated as second-line treatment in 22 patients after ICT. Salvage surgery for residuals after CRT was performed in 11 patients. Of the 33 patients who underwent surgery, postoperative complications occurred in 13 patients and R0 resection was obtained in 22 patients. Median OS was 10.2/27.2/17.4 months in the CF/DCF/CRT group (DCF>CF, p=0.01). Cancer free group (R0 resection or CR, n=39) had a better prognosis than non-cancer free group (n=46) (41.0 vs. 8.5 months, p<0.001).
Conversion surgery may be a promising strategy to improve the prognosis in the patients with cT4b esophageal cancer. Future studies are needed to determine whether the combination of immune checkpoint inhibitors and conversion surgery can improve cancer free rates.
Index Term 1: conversion surgery
Index Term 2: esophageal cancer
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