Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy for borderline resectable esophageal squamous cell carcinoma; A retrospective cohort study with short- and mid-term oncological outcomes

Abstract

Abstract Background The best treatment strategy for borderline resectable locally advanced esophageal squamous cell carcinoma (ESCC) is unknown. Although neoadjuvant chemoradiotherapy (NACRT) provides good local control, the subsequent surgery is complicated by edema or fibrosis, particularly in minimally invasive esophagectomy (MIE). This retrospective cohort study sought to assess the feasibility of NACRT followed by MIE for borderline resectable ESCC. Methods Consecutive patients who underwent NACRT (40Gy radiotherapy with chemotherapy of 5-FU and Cisplatin) followed by MIE with gastric tube reconstruction for locally advanced ESCC were included. Following a review of pretreatment CT by 2 independent physicians, clinically borderline resectable T3 (cT3br) tumors were chosen, with resectable (cT3r) and unresectable (cT4b) tumors excluded. The short- and mid-term oncological outcomes were assessed. Results Patients with 33 cT3br tumors were included. There was no postoperative mortality, and 11 and 7 patients had postoperative Clavien-Dindo Grade ≥ II and Grade ≥ III complications, respectively. R0 resection was achieved in 32 patients, with 4 patients showing pathological complete response. With a median follow-up of 675 days, 15 patients had relapsed, the majority of which included distant metastasis, and only one patient had a pure locoregional recurrence. Patients who experienced postoperative complications had significantly lower relapse-free survival (RFS) than those who did not (p = 0.049) (2-year RFS: 0% and 65%, respectively). Conclusions NACRT followed by MIE for cT3br tumors was feasible with adequate R0 resection rates. Although locoregional control was adequate, distant metastasis was poorly controlled. MIE with fewer postoperative complications would provide better oncological results.