200. SAFETY AND EFFICACY OF CONVERSION SURGERY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA. (24th September 2022)

• Record Type: Journal Article
• Authors: Tsuji, Takayuki
• Is Part Of: Diseases of the esophagus. Volume 35(2022)Supplement 2
• Publication Date: 2022-09-24
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doac051.200
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Recently, cases of conversion surgery for unresectable esophageal cancer are increasing. Last year, in Japan, Cisplatin +5-FU (CF) + Pembrolizumab is recommended as 1st line therapy for unresectable esophageal squamous cell carcinoma (ESCC), based on the results of the KEYNOTE 590 trial. With improvement of response rate, conversion surgery is expected to become a main option for treatment strategy for unresectable ESCC. 【Methods】<100. In our institute, conversion surgery is considered for patients with para-aortic lymph node-positive advanced ESCC who have no other distant metastases, if the para-aortic lymph node metastases have disappeared after systemic chemotherapy. There were 30 patients of unresectable esophageal cancer with positive para-aortic lymph node metastasis from 2011 to 2020. Seven of these patients showed disappearance of para-aortic lymph node metastasis and underwent conversion surgery. Characteristics, short-term and long-term results of these seven cases are studied. All of the seven patients who had para-aortic lymph node metastases were treated with induction DCF (Docetaxel + CF) as initial treatment. After disappearance of para-aortic lymph node metastases, thoracoscopic or open esophagectomy was performed. Four patients (57%) had Clavien-Dindo grade 2 or 3 complications, but no perioperative death was observed. Three patients (43%) had recurrence, within mediastinum lymph node, abdominal lymph node or adrenal gland. 3-year DFS was 57% and 3-year OS was 83%. Conversion surgery is safe and feasible in cases that responded to systemic chemotherapy. Some cases showed good prognosis. Long-term survival is expected with conversion surgery.