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.

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doi.org/10.1002/jso.21358, hdl.handle.net/1765/17955
Journal of Surgical Oncology
Erasmus MC: University Medical Center Rotterdam

Boonstra, J.J, Koppert, L.B, Wijnhoven, B.P.L, Tilanus, H.W, van Dekken, H, Tran, T.C.K, & 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