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Background <p>In patients with locally advanced T4 esophageal cancer, surgery is typically considered if curative resection appears feasible after chemotherapy or chemoradiotherapy. Many institutions do not perform surgery in cases with persistent T4 diseases, while some challenge combined organ resection to achieve curative resection. However, this approach may be inappropriate for patients at high risk of developing early postoperative distant metastases.</p> Methods <p>We retrospectively analyzed 445 patients with esophageal squamous cell carcinoma who were unable to undergo curative esophagectomy due to cancer invasion into surrounding organs. Survival outcomes, progression patterns, and predictive factors for distant progression as the initial site of failure were evaluated.</p> Results <p>During follow-up, 242 patients (54.8%) developed distant metastases as the initial site of progression. Multivariable analysis revealed pN2–3 (hazard ratio [HR] 2.14; 95% confidence interval [95% CI] 1.45–3.17), pM1 (HR 2.11; 95% CI 1.22–3.64), and preoperative chemotherapy (HR 1.52; 95% CI 1.09–2.11) as significant predictors of distant progression. The 2-year distant progression rates were 76.3% (95% CI 67.2%-82.9%) for pN2–3, 78.3% (95% CI 55.5%–88.4%) for pM1, and 46.3% (95% CI 32.5%–57.3%) for pN0.</p> Conclusions <p>In patients with T4 esophageal cancer and extensive lymph node metastasis, the decision to perform combined organ resection should be made with caution. Conversely, T4 patients without lymph node metastasis may benefit from extended surgery with combined organ resection.</p>

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Can combined organ resection cure T4 esophageal cancer? Insights from a multi-institutional study of incomplete resection cases

  • 期刊论文

  • 发表日期：

    2026年2月13日

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  • Akihiko Okamura,
  • Masayuki Watanabe,
  • Jun Okui,
  • Satoru Matsuda,
  • Naoki Takahashi,
  • Eisuke Booka,
  • Hirofumi Kawakubo,
  • Yuko Kitagawa,
  • Koji Kono,
  • Hiroya Takeuchi

摘要

Background

In patients with locally advanced T4 esophageal cancer, surgery is typically considered if curative resection appears feasible after chemotherapy or chemoradiotherapy. Many institutions do not perform surgery in cases with persistent T4 diseases, while some challenge combined organ resection to achieve curative resection. However, this approach may be inappropriate for patients at high risk of developing early postoperative distant metastases.

Methods

We retrospectively analyzed 445 patients with esophageal squamous cell carcinoma who were unable to undergo curative esophagectomy due to cancer invasion into surrounding organs. Survival outcomes, progression patterns, and predictive factors for distant progression as the initial site of failure were evaluated.

Results

During follow-up, 242 patients (54.8%) developed distant metastases as the initial site of progression. Multivariable analysis revealed pN2–3 (hazard ratio [HR] 2.14; 95% confidence interval [95% CI] 1.45–3.17), pM1 (HR 2.11; 95% CI 1.22–3.64), and preoperative chemotherapy (HR 1.52; 95% CI 1.09–2.11) as significant predictors of distant progression. The 2-year distant progression rates were 76.3% (95% CI 67.2%-82.9%) for pN2–3, 78.3% (95% CI 55.5%–88.4%) for pM1, and 46.3% (95% CI 32.5%–57.3%) for pN0.

Conclusions

In patients with T4 esophageal cancer and extensive lymph node metastasis, the decision to perform combined organ resection should be made with caution. Conversely, T4 patients without lymph node metastasis may benefit from extended surgery with combined organ resection.