171. CONVERSION SURGERY AFTER IMMUNE CHECKPOINT INHIBITOR IMMUNOTHERAPY FOR ESOPHAGEAL AND ESOPHAGOGASTRIC JUNCTION CANCER

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Abstract Background As a result of recent advances in the first-line treatment including immune checkpoint inhibitor (ICI) therapy for locally advanced/metastatic initially unresectable esophageal (EC) and esophagogastric junction cancers (EGJC), surgery aiming at cure after initial treatment, so-called ‘conversion surgery (CS)’ has become more common. However, utility and safety of CS after ICI remain unclear. Methods We retrospectively reviewed the 16 patients (6 patients with EGJC and 10 patients with EC) who underwent ICI followed by CS for EC and EGJC at our institute after 2022. Results The most common reason for unresectable was distant metastasis (11 cases). Preoperative immune-related adverse events (IRAE) occurred in 4 patients. Curative resection was performed for all cases. Five and 3 patients suffered postoperative complications and IRAEs (including 1 grade IV interstitial pneumonia), respectively. Two out of 3 patients with postoperative IRAEs had preoperative IRAEs. Pathological complete response was observed in 4 cases (25%), with an overall response rate of 75%. Recurrence was observed in 5 patients. Remaining 10 (63%) patients achieved major pathological responses, and are surviving without disease recurrence (median time of follow up for recurrence-free cases, 18.5 months). Conclusion Conversion surgery for EC and EGJC after ICI was successfully performed, with an acceptable safety profile. Postoperative IRAEs may be life-threatening, and a close monitoring of the patient’s condition is essential, especially for patients after preoperative IRAEs. Pathological response may be a good surrogate for survival in patients after ICI followed by CS.

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