title: Chemotherapy followed by surgery in patients with carcinoma of the distal esophagus and celiac lymph node involvement.
abstract: BACKGROUND
  Patients with carcinoma of the distal esophagus and metastatic celiac lymph nodes (M1a) have a poor prognosis and are often denied surgery. In this study, we evaluated our treatment strategy of chemotherapy followed by surgery in patients with M1a disease.
  
  
  METHODS
  Thirty-eight patients who received chemotherapy for carcinoma of the distal esophagus with celiac lymph node involvement between 2000 and 2007 were identified from a prospective database. Clinical and histopathological responses to chemotherapy were analyzed and follow-up comprised review of medical charts.
  
  
  RESULTS
  Twelve non-responding patients were not eligible for surgery. Twenty-six patients with partial responses or stable disease were operated on. The resectability rate was 96% (25/26) and tumor-free resection margins (R0) were achieved in 68% (17/25). The overall survival of patients with M1a disease was 16 months. Patients who received chemotherapy alone had a median survival of 10 months; patients who underwent additional surgery had a median survival of 26 months (log-rank P < 0.001).
  
  
  CONCLUSIONS
  The overall survival of patients with carcinoma of the distal esophagus and clinical celiac lymph node involvement is poor. Tumor-free resection margins (R0) in M1a patients with clinical response to chemotherapy are likely to be achieved and contributes to prolonged survival.
authors: Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. j.j.boonstra@erasmusmc.nl
authors: J J
authors: JJ
authors: Boonstra
authors: L B
authors: LB
authors: Koppert
authors: B P
authors: BP
authors: Wijnhoven
authors: H W
authors: HW
authors: Tilanus
authors: H
authors: H
authors: Van Dekken
authors: T C K
authors: TC
authors: Tran
authors: A
authors: A
authors: Van der Gaast
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D044963:Biopsy, Fine-Needle; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D002447:Celiac Plexus / Q000473:pathology* / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D016208:Databases, Factual; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D012189:Retrospective Studies
chemical_list: D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin