title: Esophageal cancer management: preoperative CA19.9 and CEA serum levels may identify occult advanced adenocarcinoma.
abstract: BACKGROUND
  Esophagectomy is contraindicated in case of advanced cancer (i.e., carcinomatosis, distant metastasis, and invasion of other organs). In some cases, preoperative imaging may fail to identify advanced neoplasm and esophagectomy is inappropriately planned. The aim of the study was to identify preoperative biomarkers of occult advanced disease that force surgeons to abort the planned esophagectomy.
  
  
  METHODS
  From 2008 to 2014, 244 consecutive patients were taken to the operative room to have esophagectomy for cancer in our department. All of them had blood test at admission and their preoperative biomarker data were retrieved. Their medical history was collected and the intraoperative findings and outcome were recorded. Non parametric tests, multiple regression analysis, and ROC curves analysis were performed.
  
  
  RESULTS
  In our study group, 14 (5.7 %) patients, scheduled for esophagectomy, were discovered to have occult advanced disease at laparotomy/laparoscopy or at thoracotomy. Six of them had peritoneal carcinomatosis, three had advanced tumor invading other organs, three had small liver metastasis, and two pleural carcinomatosis. In all these cases, esophagectomy was aborted and a feeding jejunostomy was placed. In patients with unresectable esophageal cancer, CA19.9 and CEA serum levels were significantly higher than patients who could have esophagectomy (p < 0.001 and p = 0.003, respectively). CA19.9 and CEA resulted to be accurate biomarkers of occult advanced disease (AUC = 85 %, p < 0.001 and AUC = 73 %, p = 0.002, respectively).
  
  
  CONCLUSIONS
  Preoperative CEA and CA19.9 serum levels should be taken in consideration when evaluating patients candidate to esophagectomy for esophageal cancer to prevent inappropriate laparotomy or thoracotomy. If any doubt arises minimally invasive exploration is warranted.
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Via Gattamelata 64 2, 35128, Padua, Italy, marcoscarpa73@yahoo.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Scarpa
authors.forename: Giulia
authors.initials: G
authors.lastname: Noaro
authors.forename: Luca
authors.initials: L
authors.lastname: Saadeh
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.forename: Matteo
authors.initials: M
authors.lastname: Cagol
authors.forename: Rita
authors.initials: R
authors.lastname: Alfieri
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.forename: Carlo
authors.initials: C
authors.lastname: Castoro
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000556:secondary / Q000601:surgery; D000368:Aged; D018395:CA-19-9 Antigen / Q000097:blood*; D002272:Carcinoembryonic Antigen / Q000097:blood*; D004938:Esophageal Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000556:secondary; D010997:Pleural Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000556:secondary; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen