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Esophageal cancer presents with a high mortality amongst the solid tumors with a threefold increase in the incidence of adenocarcinoma in recent decades. Despite the use of better diagnostic and staging modalities such as EUS and PET- CT, treatment of locally advanced tumors is associated with a poor survival. We aim to see if preoperative treatment with chemo-radiation has improved survival in those patients who respond compared to those who do not.

Methods:
All esophageal surgeries performed cooperatively by two surgeons between 2005 to 2010 were retrospectively reviewed. Only those patients deemed locally advanced (>T2, Node positive) who received preoperative chemoradiation were included for analysis. All patients were staged by CT & endoscopic ultrasound.

Results:
52 patients were identified, with 5 patients excluded due to outside institution referral. Of the 47 patients, 38(81%) had adenocarcinoma versus 9 patients (19%) who had squamous cell carcinoma. Majority of the patients received Paclitaxel, Carboplatin and 5FU with radiation. The operative surgery was either a minimally invasive or open transhiatal esophagectomy with no difference in survival (p=0.09). There were 2 operative mortalities and no anastamotic leaks. Patient response to chemotherapy was designated either as No response, Partial response or complete pathologic response(cPR). 21 patients (45%) had no response, 9 ( 19%) had partial response, while 17 patients (36%) had a cPR. Median survival was respectively 22 months, 23 months and 27 months (p=0.53) (see Fig2).

Conclusions
Preoperative treatment with esophageal cancer can lend to a high complete pathologic response. Despite the encouragement of a cPR, this data would suggest that this does not translate to an improvement in survival.