Operable oesophageal cancer: preoperative prediction of complete resection

Esophagectomy remains a standard treatment for patients withresectable esophageal cancer. After complete resection (R0),survival is significantly longer than after incomplete resection, withmicroscopic (R1) or macroscopic (R2) penetration. The purpose ofthis work was to identify prospectively the factors predictive ofcomplete resection of operable esophageal cancers.Between January 1995 and January 2002, 372 patients withesophageal cancer underwent surgery with curative intent. R0resection was performed in 304 patients (81.7%), R1 in 28 (7.5%)and R2 in 40 (10.8%). Univariate and multivariate analysis included16 preoperative and operative parameters.Factors predictive of complete resection R0 were : absence of anymodification of the esophageal axis on the barium swallow(P=0.019) and a partial or complete response to preoperativeradiochemotherapy (P=0.042). Three groups of patients wereidentified. Group 1 : no deviation of the axis on the barium swallow(n=253) ; Group 2 : deviation of the axis on the barium swallow andpartial or complete response to radiochemotherapy (n=66) ; Group3 : deviation of the axis on the barium swallow and no response toradiochemotherapy or no preoperative treatment (n=53). Rates ofR0 resection were 90.1%, 74.2% and 50.9% and 5-year actuarialsurvival 46%, 37% and 0% respectively (P<0.001).Complete resection of esophageal cancer is predictable. Deviationaxis on the barium swallow and morphological response toneoadjuvant radiochemotherapy are variables available for allpatients at onset of therapeutic management.