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Esophageal Cancer Management: Preoperative Ca19.9 and CEA Serum Levels May Identifiy Occult Advanced Cancer
Marco Scarpa, Giulia Noaro*, Luca Maria Saadeh, Francesco Cavallin, Matteo Cagol, Rita Alfieri, Vanna Chiarion-Sileni, Luigi Corti, Carlo Castoro
Oncological Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
Background: Esophagectomy is controindicated in case of advanced cancer (i.e. carcinomatosis, distant metastasis and invasion of other organs). In some cases, preoperative imaging may fail to identify advanced neoplasm and esophagectomy is inappropriatelly planned. Few data are available on preoperative biomarkers of occult advanced disease preventing radical esophagectomy. The aim of the study was to identify possible preoperative predictors of occult advanced disease that force surgeons to abort the planned esophagectomy.
Methods: From 2008 to 2013, 192 consecutive patients were taken to the operative room (OR) to have esophagectomy for cancer in our department. All of them had blood test at admission and their preoperative biohumoral data were retrieved. Their medical history was collected and the intraoperative findings and outcome were recorded. Non parametric tests, multiple regression analysis and ROC curves analysis were performed.
Results: In our study group, 10 (5.2%) patients, taken in the OR to have esophagectomy, were discovered to have occult advanced disease at laparotomy/laparoscopy or at thoracotomy. Four of them had peritoneal carcinomatosis, four had advanced tumour invading other organs, one had small liver metastasis and one pleural carcinomatosis. In all these cases, esophagectomy was aborted and a feeding jejunostomy was placed. In patients with occult advanced esophageal cancer CA19.9 and CEA serum levels were significantly higher than patients who could have esophagectomy (p<0.001 and p=0.01, respectively) while sodium and potassium levels were significantly lower. At multivariate analysis CA19.9 and CEA serum levels and neoadjuvant therapy resulted to be predictors of occult advanced disease preventing esophagectomy (b=-0.34, p<0.001; b=-0.28, p<0.001; b=-0.15, p=0.03, respectively). CA19.9 and CEA resulted to be accurate biomarkers of occult advanced disease (AUC=82%, p<0.001 and AUC=72%, p=0.01, respectively).
Conclusions: Preoperative CEA and CA19.9 serum levels should be taken in consideration when evaluating patients candidate to esophagectomy for esophageal cancer to prevent inappropriate laparotomies or thoracotomies. If any doubt arise minimally invasive exploration is warranted.
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