Outcomes and predictive factors in post-surgical resection of sT4a esophageal cancer

This study aimed to explore the prognostic outcomes and factors influencing survival in patients with sT4a esophageal cancer who have undergone surgical resection. This stage has been underreported in terms of comprehensive survival data and understanding of contributing factors.

A retrospective analysis was conducted on 139 patients with sT4a esophageal squamous cell carcinoma who underwent surgical treatment at a single institution between January 2013 and June 2020. Intraoperative T4a (sT4a) was defined according to the Japanese Esophageal Society (JES) criteria as tumor invasion into adjacent structures regarded surgically resectable at the time of operation, in contrast to pathological T4a (pT4a), which is determined histologically after resection. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier curves, and multivariate Cox regression models were employed to identify key prognostic factors.

Of the cohort, 95 (68.3%) patients experienced recurrence by the end of the follow-up period in July 2024. The five-year OS rate was 33.0%, with a median OS of 26 months. The five-year RFS was 31.7%, with a median RFS of 17 months. Key prognostic factors affecting survival and recurrence included preoperative treatment, azygos vein involvement, and specific recurrence patterns. The presence of azygos vein invasion emerged as a crucial predictor of increased recurrence risk and higher mortality.

Surgical resection remains essential for managing sT4a esophageal cancer, while patient outcomes are heavily influenced by specific anatomical and pathological factors. The findings highlighted the importance of comprehensive preoperative evaluations and individualized treatment plans to enhance survival and quality of life in this high-risk patient group.