TY - JOUR
T1 - Synchronous Esophageal and Lung Cancers—Is Combined Anatomic Resection Appropriate?
AU - Zhao, Hedi
AU - Misariu, Ana Maria
AU - Ramirez-GarciaLuna, Jose L.
AU - Nobel, Tamar
AU - Mueller, Carmen
AU - Cools-Lartigue, Jonathan
AU - Spicer, Jonathan
AU - Molena, Daniela
AU - Bains, Manjit
AU - Swisher, Stephen
AU - Hofstetter, Wayne
AU - Ferri, Lorenzo
N1 - Publisher Copyright:
© 2022 The Society of Thoracic Surgeons
PY - 2022/4
Y1 - 2022/4
N2 - 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.
AB - 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.
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U2 - 10.1016/j.athoracsur.2021.04.026
DO - 10.1016/j.athoracsur.2021.04.026
M3 - Article
C2 - 33905733
AN - SCOPUS:85118146661
SN - 0003-4975
VL - 113
SP - 1354
EP - 1360
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 4
ER -