OGC P41 Long term Outcomes after curative treatment of lower oesophageal squamous cell carcinoma: Single centre study

Abstract

Abstract Background Over the past few decades the incidence of squamous cell carcinoma (SCC) of lower oesophagus has decreased slightly. While multimodal therapy for resectable oesophageal cancer has shown definite benefits in management of adenocarcinoma of oesophagus, the ideal therapeutic modality for management of lower oesophageal SCC remains unclear. Worldwide there are a wide variations in the management of lower oesophageal squamous cell carcinoma. Except for a small proportion of patients with early cancers confined to the mucosa, curative therapies for Oesophageal SCC entail either neoadjuvant chemo-radiotherapy (CTRT) followed by oncological resection or radical chemo/radiotherapy. However, there are no clear guidelines to support either modality. The purpose of this study was to assess various curative treatment modalities for lower oesophageal SCC and analyse the short and long term outcomes. Methods Data of patients with histologically proven distal oesophageal SCC treated at a single OG resection Centre in North East London between 2011 and 2021, was retrospectively collected from a prospectively maintained database. All patients were discussed in Upper GI MDT for management plan.The lower oesophagus was defined as distal third of oesophagus below the tracheal bifurcation. In the patients who underwent surgery, post operative complications were recorded according to Clavien Dindo classification. Results Between January 2011 to December 2021, 34 patients with lower oesophageal SCC were treated at our Centre. The median age of patients was 72 +/-2 years. 47.06% were females. The median Charlson Co morbidity index was 5. 25 (73.53%) patients received definitive chemo-radiotherapy. 20.58% received neoadjuvant treatment. Overall, 20.58% patients with lower oesophageal SCC underwent surgical resection (Five with neoadjuvant and two i.e. 5.89% went straight for surgery). Median age of patients received definitive radiotherapy was 72+/-9 years as compared to median age of 67+/- 9 years in those who underwent resection. Most patients had stage III disease (16 patients). Severe surgical complications defined as Clavein Dino Grade III/IV occurred in two patients. There were no post operative mortalities. Overall median survival was 24 months. 5-year survival 20.58%. Median survival in patients who received definitive CTRT was 13 +/- 21 months, while those who were operated had a median survival of 72 +/- 39 months. Conclusions We reported the management and outcomes of lower oesophageal SCC over a period of 10 years. These findings are limited due to the small number of cases. A multicentre study to assess the management and outcomes of this group of cancer will assist in the future development of guidelines.