Outcome of Conversion Surgery After Induction Therapy for Esophageal Cancer with Synchronous Para-Aortic Lymph Node Metastasis: A Multi-institutional Retrospective Study

Abstract Background Systemic chemotherapy is the standard treatment for esophageal cancer with synchronous distant metastasis including para-aortic lymph node (PALN) metastasis. The significance of conversion surgery for esophageal cancer with synchronous PALN metastasis remains controversial. Objective The current study aimed to investigate the clinical outcome of conversion surgery for esophageal cancer with synchronous PALN metastasis after induction therapy. Methods This multi-institutional retrospective study included 48 patients with esophageal cancer who exhibited synchronous PALN metastasis and who received induction chemotherapy or chemoradiotherapy followed by conversion surgery between 2005 and 2022. The short- and long-term treatment outcomes were examined. Results Among the 48 patients, 45 and 3 received chemotherapy and chemoradiotherapy, respectively, as the initial treatment. Moreover, all patients underwent subtotal esophagectomy. The incidence rate of postoperative complications was 48% and the in-hospital mortality rate was 2%. The 3- and 5-year overall survival rates of all patients were 36.1% and 25.2%, respectively. The overall survival rates of patients with pN2-3 and final PALN status (fM1) were significantly lower than that of patients with pN0-1 ( p = 0.0025) and fM0 ( p = 0.0043). The multivariate analysis showed that pathological nodal status (hazard ratio 2.44, p = 0.0488) and fM status (hazard ratio 2.53, p = 0.0246) were independent prognostic factors. Conclusions Conversion surgery for esophageal cancer with synchronous PALN metastasis is feasible and promising. In addition, conversion surgery for patients with controlled nodal status including PALN metastasis is important for long-term prognosis.