Perioperative management of non-metastatic gastroesophageal cancer in a Philippine university hospital: a 10-year experience

TL;DR

This study examines the 10-year experience of managing non-metastatic GEJ cancer in a Philippine hospital, highlighting treatment outcomes and challenges in a low-resource setting.

Contribution

The study provides insights into multimodal treatment strategies for GEJ cancer in a low-resource environment over a decade.

Findings

Neoadjuvant therapy was associated with reduced margin positivity and improved tumor regression.

The overall survival rate was 14%, with higher cancer-specific survival in the neoadjuvant group.

Treatment-related toxicity and low surgical volumes were identified as major challenges.

Abstract

Gastroesophageal junction (GEJ) cancer has remained a significant global health challenge due to late-stage diagnosis and poor survival outcomes. This study presents the 10-year institutional experience in the multimodal management of non-metastatic GEJ cancer in a low-resource setting.

This is a retrospective cohort study of 101 patients with non-metastatic GEJ cancer. Data on demographics, tumor characteristics, management approach, and outcomes were analyzed. Outcomes of patients who underwent neoadjuvant therapy versus outright surgery were compared.

Majority of the patients were males (76%), with a mean age of 56 years old (SD 11.6) and adenocarcinoma as the predominant histology (85%). Of the cohort, 40% underwent neoadjuvant therapy, predominantly FLOT chemotherapy regimen (37%) and CROSS chemoradiotherapy regimen (54%). Definitive surgery primarily left thoracoabdominal approach with distal esophagectomy and total gastrectomy, and Roux-en-y esophagojejunostomy was performed in 60% of the cases. Neoadjuvant therapy was associated with reduced margin positivity and improved tumor regression; however, it had a high rate of incomplete treatment due to toxicity or progression. Surgical and medical complications occurred in 18% and 26%, respectively, with a 7% in-hospital mortality rate. The overall survival was 14%, and the 2- and 5-year cancer-specific survival was higher in the neoadjuvant group compared to upfront surgery.

This study underscores the benefits of a multimodal treatment strategy in non-metastatic GEJ cancer; however, challenges, including low institutional surgical volumes and treatment-related toxicity, highlight areas for improvement. Strengthening multidisciplinary collaboration and access to advanced systemic therapies are essential to optimize patient outcomes in resource-limited settings.

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