title: Surgery for esophageal cancer after concomitant radiochemotherapy: oncologic and functional results.
abstract: The aim of this study was to evaluate the results of surgery after preoperative radiochemotherapy (PRCT) for esophageal cancer. This retrospective study included 88 patients scan between 1992 and 2000. The median follow-up was 55.7 months (3.3-104.1 months). Surgical mortality was 15.9%. Multivariate analysis found that the following were risk factors for surgical mortality: gamma-glutamyltransferase level > 75 UI/ml (p = 0.007), weight loss = 10% (p = 0.05), and digestive toxicity World Health Organization grade III or IV during PRCT (p = 0.019). The median overall survival was 24.9 months. The 5-year overall survival (OS) and disease-free survival (DFS) were, respectively, 33.1% and 33.2%. Complete responder patients had a 71.8% 5-year OS (p = 0.01) and a 71.8% 5-year DFS (p = 0.009). The rate of recurrence was 37.5%. Multivariate analysis found that female gender (p = 0.03), weight loss = 10% (p = 0.03), preoperative computed tomography scan bronchial contact (p = 0.01), and N+ status (pN+) at pathology examination (p = 0.0001) were predictors of poor oncologic results. Patients with high preoperative risk of surgical mortality need to be selected for intensive perioperative management. In association with surgery, PRCT improves the local control, DFS, and OS of responder patients. Morphologic evaluation for staging esophageal cancer in predicting the pathologic response after PRCT is poor or controversial. Only surgical resection can provide accurate prognostic information for staging esophageal cancer and improving local control.
authors.affiliation: Department of Surgical Oncology, Centre Regional de Lutte Centre le Cancer, 208 Rue des Apothicaires, Parc Euromedecine, 34298 Montpellier Cedex 5, France. nplaisant@valdorel.fnclcc.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Plaisant
authors.forename: Pierre
authors.initials: P
authors.lastname: Senesse
authors.forename: David
authors.initials: D
authors.lastname: Azria
authors.forename: Claire
authors.initials: C
authors.lastname: Lemanski
authors.forename: Marc
authors.initials: M
authors.lastname: Ychou
authors.forename: Francois
authors.initials: F
authors.lastname: Quenet
authors.forename: Bernard
authors.initials: B
authors.lastname: Saint-Aubert
authors.forename: Philippe
authors.initials: P
authors.lastname: Rouanet
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D019583:Dose Fractionation, Radiation; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016896:Treatment Outcome