Abstracts
2002 Digestive Disease Week

# 107774 Abstract ID: 107774 Radical En-Bloc Esophagectomy in Locally Advanced Esophageal Cancer. Does It Suffice?
Asad Kutup, Stefan B Hosch, Peter Scheunemann, Nikolas H Stoecklein, Alexander Rehders, Wolfram T Knoefel, Jacob R Izbicki, 20246 Hamburg, Germany

Purpose: Esophageal cancer still remains a malignancy with poor prognosis. Particularly in patients with locally advanced tumors (pT3, pT4, any pT2-pT4 N1) multimodal therapeutic concepts are rivalling with radical surgery. The purpose of this study was to define the effect of radical en-bloc esophagectomy without multimodal concepts on prognosis in patients with locally advanced esophageal cancers. Methods: Between 1993 and 2001 232 patients with esophageal cancer underwent radical en- bloc esophagectomy with two-field lymphadenectomy and tumor-free resection margins at our department. 100 patients had a tumor staged as pT3or pT4 All patients underwent surgery without neoadjuvant therapy. Associations between categorical parameters were assessed with Fisher's exact and Chi-square tests. The Kaplan-Meier method was used to estimate overall cancer survival and relapse-free survival. For comparison purposes log-rank tests were performed. Cox's proportional-hazards models were fitted for multivariate analysis. Results: In patients with locally advanced tumors without lymph node involvement relapse-free survival was similar to patients with lower staging without lymph node involvement (pT2). Median relapse-free survival time 55 months vs. median 54, respectively (n.s.). Even in local recurrence-free survival no significant difference was revealed (median: 55 months vs. 14). If patients with pT3-tumors displayed nodal involvement (pT3N1), however, relapse-free survival was significantly reduced (median 8 months, p<0.00001). Patients with tumors infiltrating adjacent organs (pT4) without lymph node involvement had a significantly reduced survival compared to pT3N0 patients p<0.005 (5 year survival 78% vs. 0%). Survival of these patients was comparable to patients staged pT3N1. Cox regressions analysis confirmed the independent prognostic significance of lymph node involvement (rr =6,324, p<0.00001). Conclusions: The presence of lymph node metastasis has been shown to be the most important independent prognostic factor for predicting outcome in patients with esophageal carcinoma. In patients with locally advanced tumors without lymph node involvement radical en-bloc esophagectomy can achieve excellent results that are comparable to earlier stages concerning local tumor control as well as overall survival. We conclude, that neoadjuvant therapeutic concepts should be reserved for patients with suspicious preoperative lymph node involvement.