The Impact of Multidisciplinary Approach on Survival in Esophageal Cancer/Ozofagus kanserinde multidisipliner yaklasimin surviye etkisi

• Published in: Southern Clinics of Istanbul Eurasia (SCIE) Vol. 34; no. 3; p. 189
• Main Authors: Altintas, Mehmet Mustafa, Demirhan, Recep, Cevik, Ayhan
• Format: Journal Article
• Language: Turkish
• Published: KARE Publishing 01.09.2023
• Subjects: Care and treatment; Diagnosis; Esophageal cancer; Patient outcomes; Turkey
• ISSN: 2587-0998
• DOI: 10.14744/scie.2023.98958

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 treatment of patients with esophageal cancer have better survival results than those who underwent direct surgery. Keywords: Esophageal cancer; multidisciplinary treatment; surgery. Gastrointestinal malignitelerin en agresiflerinden biri olan ozofagus kanseri, dunyada en yaygin gorulen sekizinci kanser turu olup, erkeklerde kansere bagli olumlerin altinci sirasindadir. Calismamizda, ozofagus kanseri tedavisinde multidisipliner yaklasimin surviye etkisini gostermeyi amacladik. Gerec ve Yontem: Hastanemizde Ocak 2010-Aralik 2020 yillari arasinda endoskopi ile patolojik olarak ozofagus kanseri tanisi alan ve kuratif rezeksiyon yapilan 103 hastanin kayitlari retrospektif olarak incelendi. Hastalar multidispliner tumor konseyinde degerlendirilerek her hastaya TNM evresine gore uygun tedavi (Neoadjuvan tedavi + Cerrahi veya direk Cerrahi) planlandi. T1N0M0 ve T2N0M0 hastalara direk cerrahi, T2-T3 ve lenf nodu metastaz suphesi ile lokal ileri evre olarak kabul edilenlere neoadjuvan tedavi sonrasi cerrahi uygulandi. Cerrahi yontem olarak, ozofagusun alt ve orta lokalizasyon tumorlerinde Ivor- Lewis+D2 lenf nodu diseksiyonu veya transhiyatal ozofajektomi ameliyati, orta ve ust ozofagus tumorlerinde ise McKeown ameliyati tercih edildi. Hastalarin demografik ozellikleri ile tumorun histolojik alt gurubu, Neoadjuvan Kemoradyoterapi uygulanmasi ve direk Cerrahi tedavinin, bes yillik sag kalim ve lokal nuks uzerine etkileri irdelendi. Bulgular: Calismaya alinan 103 hastanin 51'i (%49.5) erkek, 52'si (%50.5) kadindi. Yas ortalamasi 58/yil (19-79) olarak bulundu. Hastalarin 89'u (%86.4) skuamoz hucreli karsinom tumor tipine sahipken, 14'u (%13.6) adenokarsinom tumor tipindeydi. Neoadjuvan kemoradyoterapi 70 (%67.9) hastaya uygulandi. Ameliyata alinan hastalarin 38'ine (%36.8) McKeown ameliyati, 33'une (%32.1) Ivor-Lewis ameliyati ve 32'sine (%31.1) transhiyatal ozofajektomi uygulandi. Klinik takiplerinde hastalarin bes yillik ortalama sag kalim orani %60.2 iken, bu oran patolojik tip olarak skuamoz hucreli karsinom'lu hastalarda %62.4 ve adenokarsinom'lu hastalarda %50.2 saglandi, istatistiksel olarak anlamli bir fark tespit edilmedi (p>0.05). Neoadjuvan kemoradyoterapi alan 70 hastanin bes yillik sag kalim orani %69.7 (ortalama 56 ay) bulunurken, neoadjuvan tedavi uygulanmadan direk cerrahi uygulanan 33 hastanin bes yillik sag kalim orani %39.5 (ortalama 25 ay) olarak bulundu, istatistiksel olarak anlamli fark goruldu (p<0.05). Postoperatif takip doneminde 42 (%40.7) hastada tumor nuksu goruldu. Neoadjuvan kemoradyoterapi alan 70 hastanin bes yillik takipte nuks gorulme orani %31.4 (ortalama 48 ay) idi. Neoadjuvan tedavi almayan ve direk cerrahi uygulanan 33 hastanin bes yillik takipte nuks gorulme orani %60.6 (ortalama 21 ay) olarak bulundu. Neoadjuvan tedavi alan hastalarla, neoadjuvan tedavi almayanlar arasinda nuks gorulme orani istatistiksel olarak anlamli bulundu (p<0.05). Sonuc: Ozofagus kanserli hastalarin tedavisinde multidispliner yaklasimla NKRT+Cerrahi uygulamalarinin, direk Cerrahi uygulananlara gore daha iyi sag kalim sonuclarina sahip oldugu kanaatindeyiz. Anahtar Sozcukler: Cerrahi; multidisipliner tedavi; ozofagus kanseri. Ozofagus kanserinde multidisipliner yaklasimin surviye etkisi