Surgical and long-term outcomes of combined organ resection for esophageal cancer invading adjacent organs: Experience of 90 consecutive cases.

Abstract

Objective: To evaluate the feasibility of and long-term survival with combined organ resection for esophageal cancer (EC). The optimal treatment strategy for EC that is invading adjacent organs is not established.

Methods: Ninety patients with EC invading adjacent organs who underwent combined organ resection after induction treatments during the time period 2003-2023 in our institute were eligible for the study. Short- and long-term outcomes were assessed, and survival analysis was performed to identify prognostic parameters in this cohort.

Results: Most patients had primary tumors (78.9% vs 21.1% with recurrent disease). The resected organs were the trachea/bronchus in 75.6%, large vessels in 24.4%, and both in 5.6%. All but 1 patient underwent chemotherapy or chemoradiotherapy as prior induction treatment, and had R0 resection. The overall complication rate (Clavien-Dindo grade II or greater) was 54.4%, and in-hospital mortality was 2.2% (30- and 90-day mortality: 0% and 2.2%, respectively). Of the deaths, 47 (87.0%) were attributed to EC and 7 (13.0%) to other causes. Median disease-free survival was 6.5 months, and overall survival (OS) was 18.9 months. The 2-year OS values were 47.2% with trachea/bronchus resection, 38.4% with large-vessel involvement, and 37.5% if both were involved. Univariate analysis of OS demonstrated significant associations of operation time (hazard ratio [HR], 2.11; P = .0080), blood loss (HR, 2.85; P = .0003), all-layer tracheal resection (HR, 3.51; P = .0045), ypT (HR, 2.04; P = .022), and pathologic response (HR, 2.77; P = .0089).

Conclusions: If patient selection is highly selected, combined organ resection may be a feasible and promising option as a part of the multidisciplinary treatment for EC invading an adjacent organ.