RA05.01: SURGICAL MANAGEMENT OF ESOPHAGEAL SARCOMA: A MULTICENTER EUROPEAN EXPERIENCE

Abstract

Abstract Background Esophageal sarcomas (ES) are rare and evidence in literature is scarce making their management difficult. The objective is to report surgical and oncological outcomes of ES in a large multicenter European cohort. Methods This is a retrospective multicenter study including all patients who underwent en-bloc esophagectomy for ES in 7 European tertiary referral centers between 1987 and 2016. The main outcomes and measures are pathological results, early and long-term outcomes. Results Among 10,936 esophageal resections for cancer, 21 (0.2%) patients with ES were identified. The majority of tumors was located in the middle (n = 7) and distal (n = 9) third of the esophagus. Neoadjuvant chemoradiotherapy was performed in 5 patients. All the patients underwent en-bloc transthoracic esophagectomy (19 open, 2 minimally invasive). Postoperative mortality occurred in 1 patient (5%). One patient received adjuvant chemotherapy. Definitive pathological results were carcinosarcoma (n = 7), leiomyosarcoma (n = 5), and other types of sarcoma (n = 9). Median tumor length was 5 cm [1–10]. Microscopic R1 resection was present in 1 patient (5%) and 7 patients (33%) were N + . Median follow-up was 16 (3–79) months in 20 of 21 patients (95%). One-, 3- and 5-year overall survival (OS) rates were 74%, 43% and 35%, respectively. One-, 3- and 5-years disease-free survival (DFS) rates were 58%, 40% and 33% respectively. Median overall survival (OS) was 33 months for patients with a tumor ≤ 5 cm and 13 months for patients with a tumor > 5 cm (P = 0.54). Median OS was 6 months in N + patients vs. 37 months for N0 patients (P = 0.06). At the end of the follow-up period, 9 patients had died from cancer recurrences (43%), 3 patients from other reasons (14%), 1 patient was still alive with recurrence (5%) and the 7 remaining patients were free of disease (33%). Recurrence was local (n = 3), metastatic (n = 3) or both (n = 4). Conclusion Carcinosarcoma and leiomyosarcoma were the most common ES histological sub-types. Tumor size and N + disease seemed prognosis factors. Transthoracic en-bloc esophagectomy with radical lymphadenectomy should be recommended to achieve complete resection. Long-term survival remained poor with a high local and distant recurrence rate. Disclosure All authors have declared no conflicts of interest.