Early Surgical Outcome of Esophagectomy Performed for Carcinoma Esophagus after Neoadjuvant Chemotherapy – a single center experience from Sub Himalayan region

Abstract

Abstract Esophageal cancer poses a significant global health burden, characterized by high aggressiveness and mortality rates. Despite a decline in overall incidence, certain regions exhibit a rise of adenocarcinoma incidence. At present multimodality approach with neoadjuvant treatment (Chemotherapy, Radiotherapy or both) followed by surgery with or without adjuvant treatment is standard of care, although there is no standard protocol. This retrospective, conducted at a tertiary center in the Himalayan region, explores the outcomes of esophageal and gastroesophageal junctional cancer patients undergoing surgery following neoadjuvant chemotherapy. Among 106 patients, 87 received preoperative chemotherapy, with demographic data revealing a male predominance and prevalent squamous cell carcinoma histology. Neoadjuvant therapy mainly comprised taxane-platinum regimens, with subsequent surgical procedures predominantly Ivor Lewis or McKeown esophagectomies. 30-day morbidity and mortality were observed in 35.29% of cases, with nonsurgical complications, particularly respiratory issues, being the most common. Our study reported a complete pathological response in 12.5% cases and an R0 resection rate exceeding 93%. While acknowledging the study’s retrospective and non-randomized nature, these findings suggest that neoadjuvant chemotherapy facilitates safe esophageal cancer surgeries specifically in undernourished patients.