Multidisciplinary Therapy for Locally Advanced Oesophageal Cancer With Special Reference to Surgical Conversion and Salvage

Abstract

Background/aim: Unresectable oesophageal cancer with surrounding invasion carries a particularly poor prognosis. The chemoradiotherapy treatment for locally-unresectable oesophageal cancer aims to initially control local invasion before proceeding to the next treatment, and is ideally used with curative intent. The aim of this study was to investigate patient treatment course and survival to determine the best treatment and evaluate surgical intervention for these advanced cancers.

Patients and methods: A total of 147 patients who were diagnosed with clinical T4b oesophageal cancer were included in this study.

Results: Forty-three patients had undergone curative resection of the tumour and surrounding invasion at midterm evaluation, 104 patients continued with definitive chemoradiotherapy, and salvage surgery was performed in 21 patients. Multivariate analysis of disease-specific survival showed that response at the midterm evaluation and surgical intervention (conversion surgery + salvage surgery) were significant prognostic factors.

Conclusion: Surgical intervention was an independent prognostic factor, and operation should be performed in eligible patients after considering the risks and proper timing.

Keywords: Advanced oesophageal cancer; response; surgery.