289. OUTCOME OF CONVERSION SURGERY FOR ESOPHAGEAL CANCER WITH SYNCHRONOUS ABDOMINAL PARAAORTIC LYMPH NODE METASTASIS

Abstract Background and Purpose Stage IVb esophageal cancer with distant metastasis has a poor prognosis with a 5-year survival rate of approximately 10%. Among distant metastases, the treatment strategy for esophageal cancer with metastasis to the #16 para-aortic lymph node has not been defined, and the significance of surgical resection is not clear. Methods Using the database of Osaka University and related institutions, we selected 41 cases of thoracic esophageal cancer with simultaneous #16 metastasis that underwent surgical resection between 2005 and 2021, and examined treatment outcomes. Results Patient background was median age 64 (43-76) years, gender M/F = 32/9, and primary site of occupancy Ut/Mt/Lt = 1/17/23. Tumor progression was cT factor T1/T2/T3/T4 =0/6/25/10, cN factor N0/N1/N2/N3 =0/13/19/9. Chemotherapy was administered as initial therapy in 38 patients, and CRT was administered in 3. Primary esophageal resection was performed in all 41 patients, and metastases were resected in 36 patients (88%). 38 patients (93%) were eligible for R0 resection. Pathologically, pT0-2/T3-4=22(54%)/19(46%), pN0/1/2-3 8(20%)/6(15%)/27(66%), and pN2 or higher were common. The 3-/5-year survival rate for all patients was 22.8%/19.0%. In all cases, pN0-1 had significantly better survival than pN2-3 (p=0.0252). Conclusion Conversion surgery for esophageal cancer with simultaneous #16 metastasis had a relatively good outcome, suggesting that the pN factor may be a prognostic factor.