Synchronous Esophageal and Lung Cancers—Is Combined Anatomic Resection Appropriate?

Hedi Zhao, Ana Maria Misariu, Jose L. Ramirez-GarciaLuna, Tamar Nobel, Carmen Mueller, Jonathan Cools-Lartigue, Jonathan Spicer, Daniela Molena, Manjit Bains, Stephen Swisher, Wayne Hofstetter, Lorenzo Ferri

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: This study evaluated the safety and feasibility of combined resection for patients with synchronous pulmonary and esophageal cancer. Methods: Patients undergoing esophagectomy between 1997 and 2019 were identified from prospectively collected databases at 3 tertiary referral centers, and those with combined anatomic lung resection at the same setting were matched in a 1:3 ratio to esophagectomy-alone patients, based on age, sex, pathologic stage, neoadjuvant therapy, and surgical procedure. Demographic data, perioperative data, and postoperative complications were compared. Statistical analysis included the unpaired t test, Fisher exact, or χ2 test and Gehan-Breslow analysis. Results: Of 4729 esophagectomies, combined anatomic lung resection was performed in 18 patients with discrete pulmonary lesions. Matching yielded 49 patients who underwent esophagectomy only and were statistically similar compared with patients undergoing combined resections. Ivor Lewis esophagectomy and lobectomy were the most frequent procedures. Combined resections did not have a higher overall complication rate than esophagectomy alone; rather, these patients had fewer overall complications (56% vs 84%; P = .02). Specifically, there were no differences in anastomotic leak (17% vs 18%) or pulmonary complications (39% vs 33%) between combined resection and esophagectomy alone. No postoperative mortality were identified, and median overall survival was 4.1 years vs 6.5 years (P = .10). Conclusions: Patients with synchronous localized lung and esophageal cancer, although rare, should not be biased toward nonsurgical therapy, because the morbidity associated with combined esophagectomy and anatomic lung resection does not differ significantly from esophagectomy alone in this highly selected group of patients.

Original languageEnglish (US)
Pages (from-to)1354-1360
Number of pages7
JournalAnnals of Thoracic Surgery
Volume113
Issue number4
DOIs
StatePublished - Apr 2022

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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