Preoperative hiatal hernia in esophageal adenocarcinoma; does it have an impact on patient outcomes?. (February 2023)

• Record Type: Journal Article
• Authors: St-Amour, Pénélope; Mantziari, Styliani; Dromain, Clarisse; Winiker, Michael; Godat, Sebastien; Schoepfer, Alain; Demartines, Nicolas; Schäfer, Markus
• Is Part Of: Surgical oncology. Volume 46(2023)
• Publication Date: 2023-02
• Subjects: Hiatal hernia -- Esophageal adenocarcinoma -- Esophagectomy -- Oncology; HH Hiatal Hernia -- AC Adenocarcinoma -- NAT Neoadjuvant Treatment -- OS Overall Survival -- DFS Disease-Free Survival -- GERD Gastro-Esophageal Reflux Disease -- GEJ Gastro-Esophageal Junction -- EGD Esogastroduodenoscopy -- EUS Endosonography -- RCT Radiochemotherapy -- CT Chemotherapy -- TRG Tumor Regression Grade -- ECCG Esophagectomy Complications Consensus Group -- IQR Interquartile Range; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2023.101904
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Background: The impact of hiatal hernia (HH) on oncologic outcomes of patients with esophageal adenocarcinoma (AC) remains unclear. The aim of this study was to assess the effect of pre-existing HH (≥3 cm) on histologic response after neoadjuvant treatment (NAT), overall (OS) and disease-free survival (DFS). Methods: All consecutive patients with oncological esophagectomy for AC from 2012 to 2018 in our center were eligible for assessment. Categorical variables were compared with the X 2 or Fisher's test, continuous ones with the Mann-Whitney-U test, and survival with the Kaplan-Meier and log-rank test. Results: Overall, 101 patients were included; 33 (32.7%) had a pre-existing HH. There were no baseline differences between HH and non-HH patients. NAT was used in 81.8% HH and 80.9% non-HH patients (p = 0.910), most often chemoradiation (63.6% and 57.4% respectively, p = 0.423). Good response to NAT (TRG 1–2) was observed in 36.4% of HH versus 32.4% of non-HH patients (p = 0.297), whereas R0 resection was achieved in 90.9% versus 94.1% respectively (p = 0.551). Three-year OS was comparable for the two groups (52.4% in HH, 56.5% in non-HH patients, p = 0.765), as was 3-year DFS (32.7% for HH versus 45.6% for non-HH patients, p = 0.283). Conclusion: HH ≥ 3 cm are common in patients with esophageal AC, concerning 32.7% of all patients in this series. However, its presence was neither associated with more advanced disease upon diagnosis, worse response to NAT, nor overall and disease-free survival. Therefore, such HH should not be considered as risk factor that negatively affects oncological outcome after multimodal treatment of esophageal AC. Highlights: A clinically significant HH is frequent among esophageal adenocarcinoma patients, observed in 32.7% of all AC patients, in the present series. The presence of a HH was not correlated with more advanced cancer stage upon diagnosis. The presence of a HH is not associated with poorer surgical outcomes, histologic response to treatment or long-term survival. The presence of a HH may indicate a higher location of the tumor epicenter and thus influence surgical strategy choice.