Impact of Neoadjuvant Chemoradiotherapy on Postoperative Outcomes After Esophageal Cancer Resection: Results of a European Multicenter Study

• Published in: Annals of surgery Vol. 260; no. 5; pp. 764 - 771
• Main Authors: Gronnier, Caroline, Tréchot, Boris, Duhamel, Alain, Mabrut, Jean-Yves, Bail, Jean-Pierre, Carrere, Nicolas, Lefevre, Jérémie H., Brigand, Cécile, Vaillant, Jean-Christophe, Adham, Mustapha, Msika, Simon, Demartines, Nicolas, El Nakadi, Issam, Piessen, Guillaume, Meunier, Bernard, Collet, Denis, Mariette, Christophe
• Format: Journal Article
• Language: English
• Published: United States by Lippincott Williams & Wilkins 01-11-2014
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adult; Aged; Aged, 80 and over; Anastomotic Leak - epidemiology; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Chemoradiotherapy; Diagnostic Imaging; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Europe - epidemiology; Female; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoadjuvant Therapy; Postoperative Complications - epidemiology; Propensity Score; Risk Factors; Treatment Outcome; Europe
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0000000000000955

To assess the impact of neoadjuvant chemoradiotherapy (NCRT) on anastomotic leakage (AL) and other postoperative outcomes after esophageal cancer (EC) resection.
Conflicting data have emerged from randomized studies regarding the impact of NCRT on AL.
Among 2944 consecutive patients operated on for EC between 2000 and 2010 in 30 European centers, patients treated by NCRT after surgery (n=593) were compared with those treated by primary surgery (n=1487). Multivariable analyses and propensity score matching were used to compensate for the differences in some baseline characteristics.
Patients in the NCRT group were younger, with a higher prevalence of male sex, malnutrition, advanced tumor stage, squamous cell carcinoma, and surgery after 2005 when compared with the primary surgery group. Postoperative AL rates were 8.8% versus 10.6% (P=0.220), and 90-day postoperative mortality and morbidity rates were 9.3% versus 7.2% (P=0.110) and 33.4% versus 32.1% (P=0.564), respectively. Pulmonary complication rates did not differ between groups (24.6% vs 22.5%; P=0.291), whereas chylothorax (2.5% vs 1.2%; P=0.020), cardiovascular complications (8.6% vs 0.1%; P=0.037), and thromboembolic events (8.6% vs 6.0%; P=0.037) were higher in the NCRT group. After propensity score matching, AL rates were 8.8% versus 11.3% (P=0.228), with more chylothorax (2.5% vs 0.7%; P=0.030) and trend toward more cardiovascular and thromboembolic events in the NCRT group (P=0.069). Predictors of AL were high American Society of Anesthesiologists scores, supracarinal tumoral location, and cervical anastomosis, but not NCRT.
Neoadjuvant chemoradiotherapy does not have an impact on the AL rate after EC resection (NCT 01927016).