Delaying surgery after neoadjuvant chemoradiotherapy does not significantly influence postoperative morbidity or oncological outcome in patients with oesophageal adenocarcinoma

• Published in: European journal of surgical oncology 2016-08, Vol.42 (8), p.1183-1190
• Main Authors: Kathiravetpillai, N., MD, Koëter, M., MD, van der Sangen, M.J.C., MD, PhD, Creemers, G.J., MD, PhD, Luyer, M.D.P., MD, PhD, Rutten, H.J.T., MD, PhD, Nieuwenhuijzen, G.A.P., MD, PhD
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - therapy; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Carboplatin - administration & dosage; Chemoradiotherapy; Esophageal Neoplasms - pathology; Esophageal Neoplasms - therapy; Esophagectomy - methods; Female; Fluorouracil - administration & dosage; Hematology, Oncology and Palliative Medicine; Humans; Interval; Male; Middle Aged; Neoadjuvant chemoradiotherapy; Neoadjuvant Therapy; Neoplasm Staging; Oesophageal adenocarcinoma; Paclitaxel - administration & dosage; Postoperative Complications - epidemiology; Postoperative outcome; Radiotherapy, Conformal; Retrospective Studies; Surgery; Time Factors; Treatment Outcome
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2016.03.033

Abstract Background Patients with resectable oesophageal cancer are treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery within 3 to 8 weeks. In practice, surgery is often delayed for various reasons. The aim of this study was to evaluate whether delaying surgery beyond 8 weeks has an effect on postoperative morbidity, long-term survival, and pathologic response in patients treated for oesophageal ADC. Methods Patients who underwent nCRT followed by surgery, for cT1-3, N0-3, M0 ADC between 2001 and 2014 were retrospectively included from a prospectively obtained database. Patients with a time from the end of nCRT to surgery (TTS) ≤ 8 weeks were compared with patients with a TTS > 8 weeks. Results Of 190 patients, 65 had a TTS ≤ 8 weeks, and 125 had a TTS > 8 weeks. Patient characteristics were comparable for both groups, but patients with TTS > 8 weeks exhibited higher ASA scores (p = 0.013) and more comorbidities (p = 0.007). Multivariate analysis revealed that TTS did not significantly influence postoperative morbidity, pathologic complete response rates, and five-year survival rates (42% in patients with TTS ≤ 8 weeks and 37% in patients with TTS > 8 weeks). Conclusions Delaying surgery beyond 8 weeks after nCRT did not significantly influence postoperative morbidity, pathologic response, and survival in patients with non-metastatic ADC. Therefore, it appears reasonable to postpone surgery beyond 8 weeks in patients who have not yet recovered from nCRT. However, if the patient is fit for surgery, postponing surgery does not have any additional advantages.