Esophagectomy provides higher survival rates in esophageal cancer

Brendon M. Stiles

Patients with esophageal cancer who undergo esophagectomy are more likely to survive long term than patients who are recommended surgery but refuse, according to research presented at the 54th Annual Meeting of The Society of Thoracic Surgeons.

Citing increased rates of patients refusing surgery, Brendon M. Stiles, MD, of Weill Cornell Medicine, and colleagues sought to determine what kind of survival rates those individuals should expect compared with patients who choose to undergo the surgery.

“We have been concerned by the increased rates of cancer patients opting for nonsurgical therapies despite the absence of long-term survival data,” Stiles said in a press release. “While all of the nonsurgical techniques seem easier and less invasive to patients in the short term, patients should understand the long-term implications.”

Stiles and colleagues used the National Cancer Database to identify patients with esophageal cancer from 2004 to 2014 (n = 18,549). Of that group, they found 708 patients who declined recommended surgery. The patients in that group received treatment in the form of definitive chemoradiation (n = 292; 41%), sequential chemotherapy/radiation (n = 256; 36%) or radiation or chemotherapy alone (n = 58; 8.2%). An additional 102 patients received no treatment (14%).

The researchers used propensity matching to compare patients who refused surgery (n = 525) with patients treated with preoperative therapy followed by surgery (n = 525). They found that median survival rates were significantly higher in the surgical group (32 months) compared with the nonsurgical group (22 months; P < 0.001).

Although the investigators expected patients with advanced disease to be more dismissive of surgery, they were disappointed to find that so many patients in the early stages of the disease would decline a potentially life-saving surgery.

“Although it may be tempting for patients to opt for nonsurgical treatment for cardiothoracic diseases in order to avoid the perceived pain and complication of surgery, this choice may come with a price,” Stiles said in the press release.

Stiles and colleagues added that it was important to inform patients as much as possible about their treatment options, especially early in the process. They recommended that patients should meet with a general thoracic surgeon, so they can better understand that surgery could increase their chances of surviving esophageal cancer. – by Alex Young

Reference:

Rahouma M, et al. Presented at: The 54th Annual Meeting of The Society of Thoracic Surgeons; Jan. 27-31, 2018; Fort Lauderdale, FL.

Disclosures: Stiles is employed by Pfizer.