Conversion surgery following immunochemotherapy for initially unresectable/recurrent esophageal cancer

Makino, Tomoki; Nakai, Shigeto; Hagi, Takaomi; Momose, Kota; Yamashita, Kotaro; Saito, Takuro; Tanaka, Koji; Takahashi, Tsuyoshi; Motoori, Masaaki; Kurokawa, Yukinori; Kimura, Yutaka; Nakajima, Kiyokazu; Eguchi, Hidetoshi; Doki, Yuichiro

doi:https://doi.org/10.1007/s10388-025-01176-x

Conversion surgery following immunochemotherapy for initially unresectable/recurrent esophageal cancer

Makino, Tomoki; Nakai, Shigeto; Hagi, Takaomi et al.

Esophagus, 2025

Number of Access:617（2026-06-02 04:05 Counts）

Identifier to cite or link to this item: https://hdl.handle.net/11094/103621

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Esophagus	pdf	None	351 KB	2026.12.05	Accepted Manuscript
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Table1-4	pdf	None	164 KB	2026.12.05	Table1-4
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Title	Conversion surgery following immunochemotherapy for initially unresectable/recurrent esophageal cancer
Creator	NRID 1000080528620 1000080528620 ORCID 0000-0001-7918-4217 0000-0001-7918-4217 researchmap permalink _-_-_- _-_-_- Scopus Author ID 56339970700 56339970700 CreatorName Makino, Tomoki
	NRID 1000040912027 1000040912027 ORCID 0009-0002-8713-9365 0009-0002-8713-9365 Scopus Author ID 57201910767 57201910767 CreatorName Nakai, Shigeto
	NRID 1000050804465 1000050804465 ORCID 0000-0002-4028-2714 0000-0002-4028-2714 researchmap permalink thagi thagi Scopus Author ID 57209822096 57209822096 CreatorName Hagi, Takaomi
	NRID 1000050749752 1000050749752 ORCID 0009-0004-2623-2122 0009-0004-2623-2122 researchmap permalink kom2005 kom2005 Scopus Author ID 59711925000 59711925000 CreatorName Momose, Kota
	NRID 1000020747159 1000020747159 researchmap permalink k-yamashita k-yamashita Scopus Author ID 57191498316 57191498316 CreatorName Yamashita, Kotaro
	NRID 1000020646468 1000020646468 ORCID 0000-0002-1733-5064 0000-0002-1733-5064 researchmap permalink tsaito19 tsaito19 Scopus Author ID 57211629912 57211629912 CreatorName Saito, Takuro
	NRID 1000070621019 1000070621019 ORCID 0000-0001-5178-9388 0000-0001-5178-9388 researchmap permalink koji_tanaka koji_tanaka Scopus Author ID 55628548952 55628548952 CreatorName Tanaka, Koji
	NRID 1000050452389 1000050452389 ORCID 0000-0003-2397-1478 0000-0003-2397-1478 researchmap permalink mihogaoka13611 mihogaoka13611 Scopus Author ID 56182761100 56182761100 CreatorName Takahashi, Tsuyoshi
	CreatorName Motoori, Masaaki
	NRID 1000010470197 1000010470197 ORCID 0000-0002-2883-0132 0000-0002-2883-0132 researchmap permalink krkw krkw Scopus Author ID 7202562410 7202562410 CreatorName Kurokawa, Yukinori
	NRID 1000080716994 1000080716994 CreatorName Kimura, Yutaka
	NRID 1000030432537 1000030432537 ORCID 0000-0001-8635-7585 0000-0001-8635-7585 researchmap permalink project_engine project_engine Scopus Author ID 7404396263 7404396263 CreatorName Nakajima, Kiyokazu
	NRID 1000090542118 1000090542118 ORCID 0000-0002-2318-1129 0000-0002-2318-1129 researchmap permalink abcdabcdabcd abcdabcdabcd Scopus Author ID 7101627772 7101627772 CreatorName Eguchi, Hidetoshi
	NRID 1000020291445 1000020291445 researchmap permalink ydoki3251 ydoki3251 Scopus Author ID 7006390687 7006390687 CreatorName Doki, Yuichiro
Subject	Conversion surgery
	Esophageal cancer
	Immunochemotherapy
	Recurrence
	Stage IV
Description	This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s10388-025-01176-x.
Abstract	Objective: Conversion surgery (CS) after immunochemotherapy is a potential treatment option for patients with initially unresectable or recurrent esophageal cancer. However, the safety, pathological response, and oncological outcomes remain insufficiently defined. Methods: This retrospective analysis included 36 consecutive patients who underwent CS after receiving a median 3 (range 2–7) cycles of induction immunochemotherapy for cStage IV or recurrent esophageal cancer between 2022 and 2025. We assessed the clinical response, perioperative outcomes, pathological findings, and survival. Results: Patients received a median of 3 cycles (range 2–7) of immunochemotherapy. Treatment-related adverse events were generally manageable, with neutropenia being the most common (55.6%), followed by hyponatremia (19.4%) and anemia (19.4%). The clinical response rate was 80.6%, and R0 resection was achieved in 94.4% of patients. All cM1 cases (n = 24) except one underwent minimally invasive subtotal esophagectomy with two-field (n = 11) or three-field (n = 17) lymphadenectomy. Postoperative complications (Clavien–Dindo grade II or higher) occurred in 63.4%, most frequently pneumonia (27.8%) and disorder of sputum expectoration (13.9%); neither postoperative immune-related morbidity nor 90-day mortality/readmission were observed. The rate of pathological complete response in the primary tumor was 27.6%, whereas clinical complete response/pathological complete response rates at metastatic sites were 46.4/56.6% in regional nodes, 65.0/26.1% in distant nodes, and 100/66.7% in distant organ lesions. Conclusions: CS following immunochemotherapy is feasible and safe in selected patients with cStage IV or recurrent esophageal cancer. The long-term prognostic significance of CS remains to be determined and will require further studies.
Publisher	Springer
Source Title	Esophagus
Date of Issued	2025-12-05
Language	English
Handle URL	https://hdl.handle.net/11094/103621
PISSN	16129059
eISSN	16129067
Relation.isVersionOf	DOI (Publisher Version) https://doi.org/10.1007/s10388-025-01176-x
Access Rights	embargoed access
CopyRight	The full-text file will be made open to the public on 5 December 2026 in accordance with the publisher's policy.
oaire:version	Accepted Manuscript
Category	学術雑誌論文 Journal Article

Resource Type	journal article
Local Type	Journal Article
DCMI Type	Text
DCTERMS.bibliographicCitation	Esophagus. 2025
DC.title	Conversion surgery following immunochemotherapy for initially unresectable/recurrent esophageal cancer
DC.creator	Makino, Tomoki
	Nakai, Shigeto
	Hagi, Takaomi
	Momose, Kota
	Yamashita, Kotaro
	Saito, Takuro
	Tanaka, Koji
	Takahashi, Tsuyoshi
	Motoori, Masaaki
	Kurokawa, Yukinori
	Kimura, Yutaka
	Nakajima, Kiyokazu
	Eguchi, Hidetoshi
	Doki, Yuichiro
DC.publisher	Springer
DC.language' scheme='DCTERMS.RFC1766	English
DC.type' scheme='DCTERMS.DCMIType	Text
DCTERMS.issued' scheme='DCTERMS.W3CDTF	2025-12-05
DC.identifier	https://doi.org/10.1007/s10388-025-01176-x
DC.subject	Conversion surgery
	Esophageal cancer
	Immunochemotherapy
	Recurrence
	Stage IV
DC.description	This version of the article has been accepted for publication, after peer review (when applicable) and is subject to Springer Nature’s AM terms of use, but is not the Version of Record and does not reflect post-acceptance improvements, or any corrections. The Version of Record is available online at: https://doi.org/10.1007/s10388-025-01176-x.
DCTERMS.abstract	Objective: Conversion surgery (CS) after immunochemotherapy is a potential treatment option for patients with initially unresectable or recurrent esophageal cancer. However, the safety, pathological response, and oncological outcomes remain insufficiently defined. Methods: This retrospective analysis included 36 consecutive patients who underwent CS after receiving a median 3 (range 2–7) cycles of induction immunochemotherapy for cStage IV or recurrent esophageal cancer between 2022 and 2025. We assessed the clinical response, perioperative outcomes, pathological findings, and survival. Results: Patients received a median of 3 cycles (range 2–7) of immunochemotherapy. Treatment-related adverse events were generally manageable, with neutropenia being the most common (55.6%), followed by hyponatremia (19.4%) and anemia (19.4%). The clinical response rate was 80.6%, and R0 resection was achieved in 94.4% of patients. All cM1 cases (n = 24) except one underwent minimally invasive subtotal esophagectomy with two-field (n = 11) or three-field (n = 17) lymphadenectomy. Postoperative complications (Clavien–Dindo grade II or higher) occurred in 63.4%, most frequently pneumonia (27.8%) and disorder of sputum expectoration (13.9%); neither postoperative immune-related morbidity nor 90-day mortality/readmission were observed. The rate of pathological complete response in the primary tumor was 27.6%, whereas clinical complete response/pathological complete response rates at metastatic sites were 46.4/56.6% in regional nodes, 65.0/26.1% in distant nodes, and 100/66.7% in distant organ lesions. Conclusions: CS following immunochemotherapy is feasible and safe in selected patients with cStage IV or recurrent esophageal cancer. The long-term prognostic significance of CS remains to be determined and will require further studies.
DC.rights	The full-text file will be made open to the public on 5 December 2026 in accordance with the publisher's policy.
DC.format	103621
citation_title	Conversion surgery following immunochemotherapy for initially unresectable/recurrent esophageal cancer
citation_author	Makino, Tomoki
	Nakai, Shigeto
	Hagi, Takaomi
	Momose, Kota
	Yamashita, Kotaro
	Saito, Takuro
	Tanaka, Koji
	Takahashi, Tsuyoshi
	Motoori, Masaaki
	Kurokawa, Yukinori
	Kimura, Yutaka
	Nakajima, Kiyokazu
	Eguchi, Hidetoshi
	Doki, Yuichiro
citation_publisher	Springer
citation_language	English
citation_date	2025-12-05
citation_journal_title	Esophagus
citation_doi	https://doi.org/10.1007/s10388-025-01176-x
citation_public_url	https://hdl.handle.net/11094/103621

Conversion surgery following immunochemotherapy for initially unresectable/recurrent esophageal cancer

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