Kutup, Asad, Nentwich, Michael F. ORCID: 0000-0001-7510-7230, Bollschweiler, Elfriede, Bogoevski, Dean, Izbicki, Jakob R. and Hoelscher, Arnulf H. (2014). What Should Be the Gold Standard for the Surgical Component in the Treatment of Locally Advanced Esophageal Cancer Transthoracic Versus Transhiatal Esophagectomy. Ann. Surg., 260 (6). S. 1016 - 1023. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1528-1140

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Abstract

Objective: To analyze survival differences between transthoracic esophagectomy (TTE) and limited transhiatal esophagectomy (THE) in clinically (cT3) and pathologically (pT3) staged advanced tumors without neoadjuvant treatment. Background: Debate exists whether in the type of resection in locally advanced cancer plays a role in prognosis and whether THE is a valuable alternative to TTE regarding oncological doctrine and overall survival. Methods: In a retrospective study of 2 high-volume centers, 468 patients with cT3NXM0 esophageal cancer, including 242 (51.7%) squamous cell carcinomas (SCCs) and 226 (48.3%) adenocarcinomas (ACs), were analyzed. A total of 341 (72.9%) TTE and 127 (27.1%) THE were performed. We used the propensity score matching to build comparable groups. Primary endpoint was the overall survival; secondary endpoints included resection status and lymph node yield. Results: TTE achieved a higher rate of R0 resections (86.2% vs 73.2%; P = 0.001) and a higher median lymph node yield (27.0 +/- 12.4 vs 17.0 +/- 6.4; P < 0.001) than THE. Thirty-day mortality rate was 6.6% (8/121) for TTE and 7.4% (9/121) for THE (P = 0.600). In the matched groups, TTE was beneficial for pT3 SCC (P = 0.004), pT3 AC (P = 0.029), cT3 SCC (P = 0.018), and cT3 AC (P = 0.028) patients. TTE was either beneficial in pN2 disease for cT3 AC + SCC or pT3 SCC but not for pT3 AC patients, without nodal stratification in pT3 and cT3 SCC node-positive patients. On multivariable analysis, TTE remained an independent factor for survival. Conclusions: Extended TTE achieved a higher rate of R0 resections, a higher lymph node yield, and resulted in a prolonged survival than THE in pT3, cT3, and node-positive patients.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Kutup, AsadUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nentwich, Michael F.UNSPECIFIEDorcid.org/0000-0001-7510-7230UNSPECIFIED
Bollschweiler, ElfriedeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bogoevski, DeanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Izbicki, Jakob R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hoelscher, Arnulf H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-422340
DOI: 10.1097/SLA.0000000000000335
Journal or Publication Title: Ann. Surg.
Volume: 260
Number: 6
Page Range: S. 1016 - 1023
Date: 2014
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Place of Publication: PHILADELPHIA
ISSN: 1528-1140
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
5-YEAR SURVIVAL; LYMPH-NODES; EN-BLOC; CARCINOMA; RESECTION; CHEMORADIOTHERAPY; ADENOCARCINORNA; SURGERY; NUMBER; METAANALYSISMultiple languages
SurgeryMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/42234

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