BACKGROUND: Patients with carcinoma of the distal esophagus and metastatic celiac lymph nodes (M1a) have a poor prognosis and are often denied surgery. In this study, we evaluated our treatment strategy of chemotherapy followed by surgery in patients with M1a disease. METHODS: Thirty-eight patients who received chemotherapy for carcinoma of the distal esophagus with celiac lymph node involvement between 2000 and 2007 were identified from a prospective database. Clinical and histopathological responses to chemotherapy were analyzed and follow-up comprised review of medical charts. RESULTS: Twelve non-responding patients were not eligible for surgery. Twenty-six patients with partial responses or stable disease were operated on. The resectability rate was 96% (25/26) and tumor-free resection margins (R0) were achieved in 68% (17/25). The overall survival of patients with M1a disease was 16 months. Patients who received chemotherapy alone had a median survival of 10 months; patients who underwent additional surgery had a median survival of 26 months (log-rank P < 0.001). CONCLUSION: The overall survival of patients with carcinoma of the distal esophagus and clinical celiac lymph node involvement is poor. Tumor-free resection margins (R0) in M1a patients with clinical response to chemotherapy are likely to be achieved and contributes to prolonged survival. (c) 2009 Wiley-Liss, Inc.

Additional Metadata
Keywords Kaplan Meier method, adenocarcinoma, adult, aged, antineoplastic agent, article, carboplatin, celiac plexus, cisplatin, esophagus resection, esophagus tumor, factual database, female, human, laparoscopy, lymph node, lymph node metastasis, lymphadenectomy, male, middle aged, mortality, needle biopsy, paclitaxel, pathology, retrospective study, squamous cell carcinoma
Persistent URL dx.doi.org/10.1002/jso.21358, hdl.handle.net/1765/17955
Citation
Boonstra, J.J., Koppert, L.B., Wijnhoven, B.P.L., Tilanus, H.W., van Dekken, H., Tran, T.C., & van der Gaast, A.. (2009). Chemotherapy followed by surgery in patients with carcinoma of the distal esophagus and celiac lymph node involvement.. Journal of Surgical Oncology, 100(5), 407–413. doi:10.1002/jso.21358