Synchronous pulmonary and esophageal cancers: Is combined esophagectomy and anatomic lung resection appropriate?

Abstract

341 Background: Resection is the best treatment for both esophagus and lung cancer, however, concerns that a combined resection of synchronous lung/esophagus tumors might be associated with higher morbidity may preclude surgical therapy. We sought to review a multi-institutional experience on combined esophagus/lung cancer resections. Methods: Patients undergoing esophagectomy and those with concurrent anatomic resection for bronchogenic carcinoma between 1997-2018 at three high-volume North American centers were identified from prospectively collected databases. Combined resection cases (E+L) were matched in a 1:3 ratio to patients who underwent esophagectomy alone (E), based on age, sex, stage, neoadjuvant therapy, procedure (2/3hole), and approach (MIE/open). Patient demographics, tumour characteristics, and post-operative outcomes were compared. Statistical analysis was performed using unpaired t-test or Wilcoxon sum-rank test for continuous variables and Fisher’s exact test for categorical data. Statistical significance was defined as p < 0.05. Results: Of over 2500 patients undergoing esophagectomy, synchronous anatomic lung resection was performed in 20; 4 were excluded due to incomplete data (n = 16). Matching yielded 48 patients and 4 duplicates were removed (n = 44); there were no significant differences in patient demographics, neoadjuvant therapy, clinical stage, or procedure. Anatomic resection consisted of lobectomy (16/20), segmentectomy (3/20) and pneumonectomy (1/20), combined with 2-hole (14/20), 3-hole (4/20), or left thoraco-abdominal (2/20) esophagectomy. The proportion of patients with any complication in E+L was 50%, and 66% in E (p = 0.42). Pulmonary complications were 19% and 27% in the respective groups (p = 0.74). Mortality did not differ (E+L = 0/16:E = 1/44)NS. The median length of stay for both groups was similar (E+L = 10.5 days(IQR 5.7): E = 10.0 days (IQR 8.7))NS. Conclusions: Patients with synchronous localized lung and esophageal cancer, although rare, should not be biased towards non-surgery therapy, as the morbidity associated with combined esophagectomy and anatomic lung resection does not differ significantly from esophagectomy alone.