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Showing content from https://pubmed.ncbi.nlm.nih.gov/21962263/ below:

Does the timing of esophagectomy after chemoradiation affect outcome?

Comparative Study

. 2012 Jan;93(1):207-12; discussion 212-3. doi: 10.1016/j.athoracsur.2011.05.021. Epub 2011 Oct 1. Does the timing of esophagectomy after chemoradiation affect outcome? Arlene M Correa, Ara A Vaporciyan, Jack A Roth, Reza J Mehran, Garrett L Walsh, David C Rice, Jaffer A Ajani, Dipen M Maru, Manoop S Bhutani, James Welsh, Edith M Marom, Stephen G Swisher, Wayne L Hofstetter

Affiliations

Affiliation

¹ Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. jaekim@post.harvard.edu

PMID: 21962263
PMCID: PMC4041623
DOI: 10.1016/j.athoracsur.2011.05.021

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Comparative Study

Does the timing of esophagectomy after chemoradiation affect outcome?

Jae Y Kim et al. Ann Thorac Surg. 2012 Jan.

. 2012 Jan;93(1):207-12; discussion 212-3. doi: 10.1016/j.athoracsur.2011.05.021. Epub 2011 Oct 1. Authors Jae Y Kim¹, Arlene M Correa, Ara A Vaporciyan, Jack A Roth, Reza J Mehran, Garrett L Walsh, David C Rice, Jaffer A Ajani, Dipen M Maru, Manoop S Bhutani, James Welsh, Edith M Marom, Stephen G Swisher, Wayne L Hofstetter Affiliation

¹ Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. jaekim@post.harvard.edu

PMID: 21962263
PMCID: PMC4041623
DOI: 10.1016/j.athoracsur.2011.05.021

Item in Clipboard

Abstract

Background: After neoadjuvant chemoradiation (CXRT) for esophageal cancer, surgery has traditionally been recommended to be performed within 8 weeks. However, surgery is often delayed for various reasons. Data from other cancers suggest that delaying surgery may increase the pathologic complete response rate. However, there are theoretical concerns that waiting longer after radiation may lead to a more difficult operation and more complications. The optimal timing of esophagectomy after CXRT is unknown.

Methods: From a prospective database, we analyzed 266 patients with resected esophageal cancer who were treated with neoadjuvant CXRT from 2002 to 2008. Salvage resections were excluded from this analysis. We compared patients who had surgery within 8 weeks of CXRT and those who had surgery after 8 weeks. We used multivariable analysis to determine whether increased interval between chemoradiation and surgery was independently associated with perioperative complication, pathologic response, or overall survival.

Results: One hundred fifty patients were resected within 8 weeks and 116 were resected greater than 8 weeks after completing CXRT. Mean length of operation, intraoperative blood loss, anastomotic leak rate, and perioperative complication rate were similar for the two groups. Pathologic complete response rate and overall survival were also similar for the two groups (p=not significant). In multivariable analysis, timing of surgery was not an independent predictor of perioperative complication, pathologic complete response, or overall survival.

Conclusions: The timing of esophagectomy after neoadjuvant CXRT is not associated with perioperative complication, pathologic response, or overall survival. It may be reasonable to delay esophagectomy beyond 8 weeks for patients who have not yet recovered from chemoradiation.

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Figures
Figure 1

Distribution of timing of surgery…

Figure 1

Distribution of timing of surgery after CXRT.

Figure 1

Distribution of timing of surgery after CXRT.

Figure 2

Kaplan-Meier curve for overall survival.…

Figure 2

Kaplan-Meier curve for overall survival. p = 0.23.

Figure 2

Kaplan-Meier curve for overall survival. p = 0.23.

Figure 3

Kaplan-Meier curve for disease free…

Figure 3

Kaplan-Meier curve for disease free survival. p=0.17.

Figure 3

Kaplan-Meier curve for disease free survival. p=0.17.