Comparison Of Larynx-Preserving Esophagectomy And Definitive Chemoradiotherapy For Patients With Cervical Esophageal Squamous Cell Carcinoma

Aim: The purpose of this study was to analyze and compare the outcomes of patients with cervical esophageal squamous cell carcinoma (ESCC) treated with larynx-preserving esophagectomy and definitive chemoradiotherapy (dCRT). Methods: One hundred and three patients with resectable cervical ESCC who underwent larynx-preserving esophagectomy or dCRT were retrospectively analyzed. Results: Fifty patients received larynx-preserving esophagectomy, and other 53 received dCRT. The median survival durations of patients in the operation and dCRT groups were 41 and 39 months, respectively (P=0.888). Among patients with stage I/II disease, patients treated surgically had significantly better disease-free survival than those treated with dCRT (P=0.048). Patients with stage III disease in the operation group had a worse overall survival (P=0.047). Eight patients who received limited cervical esophagectomy had acceptable survival rates and quality of life. Multivariate analysis revealed that stage III disease and postoperative adjuvant therapy were the independent predictive and prognostic factors of tumor recurrence and survival rates after surgeries. Clinical complete response (CR) was the independent prognostic factor of survival after dCRT. Conclusion: Larynx-preserving esophagectomy and dCRT are effective for cervical ESCC. Patients with stage I/II disease are good candidates for surgical resection; those with stage III disease are more appropriate for dCRT. For the patients who are selected carefully, limited cervical esophagectomy with direct end-to-end anastomosis of esophagus is feasible. Stage III disease and postoperative adjuvant therapy affected tumor recurrence and survival of patients after surgeries. CR was the only factor that affected the survival rates after dCRT. The optimal treatment strategy should be considered individually.