Early intervention of the perioperative multidisciplinary team approach decreases the adverse events during neoadjuvant chemotherapy for esophageal cancer patients

• Published in: Esophagus : official journal of the Japan Esophageal Society 2021-10, Vol.18 (4), p.797-805
• Main Authors: Shirakawa, Yasuhiro, Noma, Kazuhiro, Maeda, Naoaki, Tanabe, Shunsuke, Sakurama, Kazufumi, Sonoyama-Hanaoka, Ayumi, Yoshitomi, Aiko, Kohno-Yamanaka, Reiko, Soga, Yoshihiko, Fujiwara, Toshiyoshi
• Format: Article
• Language: English
• Subjects: Cancer surgery; Cancer therapies; Chemotherapy; Esophageal cancer; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Gastroenterology; Humans; Medicine; Medicine & Public Health; Multidisciplinary teams; Neoadjuvant Therapy - adverse effects; Original Article; Patient Care Team; Surgical Oncology; Thoracic Surgery; Treatment Outcome
• ISSN: 1612-9059; 1612-9067
• DOI: 10.1007/s10388-021-00844-y

Background Multidisciplinary team (MDT) approach has become a standard for perioperative patient care, including in esophageal cancer. In our institution, the Perioperative Management Center (PERiO) has been doing an MDT approach for patients undergoing esophageal cancer surgery since 2009. On the other hand, neoadjuvant therapy has also been becoming standard for many malignancies, including esophageal cancer. In Japan, neoadjuvant chemotherapy (NAC) for esophageal cancer is standard now. However, there have been no reports about when is the best time to start the MDT approach for patients with neoadjuvant therapy. In this study, the best start time for the MDT approach for esophageal cancer patients with NAC was examined from the perspective of adverse events during chemotherapy and perioperative period. Methods All cases underwent thoracoscopic esophagectomy in the prone position (TEPP) after NAC. The PERiO Intervention group that started before NAC ( n  = 100) was compared with the PERiO Intervention group that started after NAC ( n  = 77). Eventually, 54 paired cases were matched by propensity score matching. Results The adverse event rate during chemotherapy, especially oral complications, was significantly decreased in the PERiO Intervention started before the NAC group ( P  = 0.007). Furthermore, weight loss during the period from chemotherapy to surgery was significantly reduced in the group that started before NAC ( P  = 0.033). Conclusion The MDT approach should be started before NAC in patients undergoing esophageal cancer surgery to prevent adverse events during chemotherapy and provide safe perioperative conditions.