title: Safety and benefit of curative surgical resection for esophageal squamous cell cancer associated with multiple primary cancers.
abstract: BACKGROUND
  Enhancements in surgical techniques have led to improved outcomes for esophageal cancer. Recent findings have showed that esophageal cancer is frequently associated with multiple primary cancers, and surgical resection is usually complicated in such cases. The aim of this study was to clarify the clinical significance of surgery for patients with esophageal squamous cell cancer associated with multiple primary cancers.
  
  
  METHODS
  The clinical outcomes of surgical resection for esophageal cancer were compared among 79 patients with antecedent and/or synchronous cancers (Multiple cancer group) and 194 patients without antecedent and/or synchronous cancers (Single cancer group).
  
  
  RESULTS
  The most common site of multiple primary cancers was the pharynx (36 patients; 29.7%), followed by the stomach (24 patients; 19.8%). The reconstruction method was more complicated in the Multiple cancer group as a result of the prolonged surgery time and increased blood loss. However, postoperative morbidity and overall survival (OS) did not differ between the two groups. After esophagectomy, metachronous cancers were observed in 26 patients, with 30 regions in total, and 93.1% were found to be curable. Sex was the only independent risk factors for developing metachronous cancer after esophagectomy.
  
  
  CONCLUSIONS
  The presence of antecedent and synchronous cancers complicates the surgical resection of esophageal cancer; however, no differences were found in the OS and postoperative morbidity between the two groups. Therefore, surgical intervention should be selected as a first-line treatment. Because second primary cancers are often observed in esophageal cancer, we recommend a close follow-up using esophagogastroduodenoscopy and contrast-enhanced computed tomography.
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan. Electronic address: otoway@med.kobe-u.ac.jp.
authors.forename: Y
authors.initials: Y
authors.lastname: Otowa
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: G
authors.initials: G
authors.lastname: Takiguchi
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kanaji
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan; Department of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Imanishi
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Oshikiri
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Suzuki
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan; Department of Surgery, Saiseikai Osaka Nakatsu Hospital, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kakeji
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D061214:Patient Safety; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Esophageal cancer; Esophagectomy; Multiple primary cancer; Squamous cell carcinoma