title: Outcomes associated with surgery for T4 esophageal cancer.
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.
  
  
  CONCLUSIONS
  We have demonstrated that neoadjuvant therapy and downstaging of T4 tumors leads to increased R0 resections and improvements in overall and disease-free survival.
authors.affiliation: Program of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Pimiento
authors.forename: Jill
authors.initials: J
authors.lastname: Weber
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hoffe
authors.forename: Ravi
authors.initials: R
authors.lastname: Shridhar
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Almhanna
authors.forename: Shivakumar
authors.initials: S
authors.lastname: Vignesh
authors.forename: Richard C
authors.initials: RC
authors.lastname: Karl
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Meredith
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D018572:Disease-Free Survival; D019160:Endosonography; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D012074:Remission Induction