The Impact of Multidisciplinary Approach on Survival in Esophageal Cancer

Abstract

Objective: Esophageal cancer, one of the most aggressive gastrointestinal malignancies, is the eighth-most common cancer in the world and the sixth among cancer-related deaths in men. In our study, we aimed to show the survival effect of the multidisciplinary approach in the treatment of esophageal cancer. Methods: The records of 103 patients who were diagnosed with esophageal cancer pathologically by endoscopy and underwent curative resection between January 2010 and December 2020 were reviewed retrospectively. The patients were evaluated in the multidisciplinary tumor council and appropriate treatment (neoadjuvant therapy+surgery or only surgery) was planned for each patient according to the TNM stage.T1N0M0 and T2N0M0 patients underwent direct surgery, T2-T3 and those who were considered to be locally advanced with the suspicion of lymph node metastasis underwent surgery after neoadjuvant therapy. As the surgical method, Ivor-Lewis+D2 lymph node dissection or transhiatal esophagectomy surgery was applied in lower and middle localization tumors of the esophagus, whereas McKeown surgery was preferred in middle and upper esophageal tumors. Results: Of the 103 patients included in the study, 51 (49.5%) were male and 52 (50.5%) were female. Neoadjuvant chemoradiotherapy (NCRT) was applied to 70 (67.9%) patients. While the 5-year survival rate of 70 patients who received NCRT was 69.7% (mean 56 months) of the 5-year survival rate of 33 patients who underwent direct surgery without neoadjuvant therapy was found to be 39.5 (mean 25 months), and there was a statistically significant difference observed (p<0.05). The recurrence rate in the 5-year follow-up of 70 patients who received NCRTwas 31.4% (mean 48 months). The recurrence rate in the 5-year follow-up of 33 patients who did not receive neoadjuvant treatment and underwent direct surgery was 60.6% (mean 21 months). The rate of recurrence was statistically significant between patients who received neoadjuvant therapy and those who did not receive neoadjuvant therapy (p<0.05). Conclusion: We believe that NCRT+surgery with a multidisciplinary approach in the treat-ment of patients with esophageal cancer have better survival results than those who underwent direct surgery. ABSTRACT