Original Article
Results of management of esophageal and GE junction malignancies in Nepalese context
Abstract
Background: Optimal management of esophageal and GE junction cancer in Nepal has not been studied properly. We reviewed our results to recommend some practical guidelines.
Methods: An institutional review of 327 patients was done. Locally advanced cases were subjected to neoadjuvant treatment prior to surgery, whereas resectable cases were directly subjected to surgery or surgery followed by adjuvant treatment. Open and minimally invasive approaches were used in 246 (75%) and 81 (25%) patients, respectively.
Results: Final stages showed Ia (0.3%), Ib (2%), IIa (13%), IIb (8%), IIIa (17%), IIIb (11%), IIIc (41.7%) and IV (7%). The post operative mortality was 5.8%. Pneumonia/ pneumonitis, anastomotic leak and hoarseness of voice were observed in 21%, 11.6% and 7.6%, respectively. Median survival (in months) was as follows: St Ia - 60, Ib - 15, IIa - 23, IIb - 18, IIIa - 15, IIIb - 15, IIIc - 11 and IV - 8.5 (P<0.001). R0 and R+ resection was achieved in 299 (91%) and 28 (9%) cases, respectively with median survival of 27 and 9 months in R0 and R+ resections, respectively (P<0.001). 5-year overall survival was 22% with median survival of 25 months. After neoadjuvant treatment, Complete responders had median survival of 25.1 vs. 12.6 months for non-responders (P=0.042).
Conclusion: Though the postoperative complications remain in acceptable range, the overall survival remains poor mainly due to the advanced stage of the disease at the time of diagnosis. Therefore, an approach of neoadjuvant chemoradiation/ chemotherapy prior to the surgery should be encouraged whenever feasible in order to achieve the best results.
Methods: An institutional review of 327 patients was done. Locally advanced cases were subjected to neoadjuvant treatment prior to surgery, whereas resectable cases were directly subjected to surgery or surgery followed by adjuvant treatment. Open and minimally invasive approaches were used in 246 (75%) and 81 (25%) patients, respectively.
Results: Final stages showed Ia (0.3%), Ib (2%), IIa (13%), IIb (8%), IIIa (17%), IIIb (11%), IIIc (41.7%) and IV (7%). The post operative mortality was 5.8%. Pneumonia/ pneumonitis, anastomotic leak and hoarseness of voice were observed in 21%, 11.6% and 7.6%, respectively. Median survival (in months) was as follows: St Ia - 60, Ib - 15, IIa - 23, IIb - 18, IIIa - 15, IIIb - 15, IIIc - 11 and IV - 8.5 (P<0.001). R0 and R+ resection was achieved in 299 (91%) and 28 (9%) cases, respectively with median survival of 27 and 9 months in R0 and R+ resections, respectively (P<0.001). 5-year overall survival was 22% with median survival of 25 months. After neoadjuvant treatment, Complete responders had median survival of 25.1 vs. 12.6 months for non-responders (P=0.042).
Conclusion: Though the postoperative complications remain in acceptable range, the overall survival remains poor mainly due to the advanced stage of the disease at the time of diagnosis. Therefore, an approach of neoadjuvant chemoradiation/ chemotherapy prior to the surgery should be encouraged whenever feasible in order to achieve the best results.
