Delayed Surgical Intervention After Chemoradiotherapy in Esophageal Cancer-Reference-Cited by-同舟云学术

Delayed Surgical Intervention After Chemoradiotherapy in Esophageal Cancer

Published:2023-07-21 Issue: Volume: Page:
ISSN:0003-4932
Container-title:Annals of Surgery
language:en
Short-container-title:

Author:

Chidambaram Swathikan¹,Owen Richard²³,Sgromo Bruno²,Chmura Magdalena²,Kisiel Aaron⁴,Evans Richard⁴,Griffiths Ewen A⁴,Castoro Carlo⁵,Gronnier Caroline⁶,MaoAwyes M⁷,Gutschow Christian A⁷,Piessen Guillaume⁸,Degisors Sébastien⁸,Alvieri Rita⁹,Feldman H¹⁰,Capovilla Giovanni¹¹,Grimminger Peter P¹¹,Han Shiwei¹²,Low Donald E¹²,Moore Jonathan¹³,Gossage James¹³,Voeten Dan¹⁴,Gisbertz Suzanne S.¹⁴,Ruurda Jelle¹⁵,van Hillegersberg Richard¹⁵,D’journo Xavier Benoit¹⁶,Phillips Alexander W¹⁷,Rosati Ricardo¹⁸,Hanna George B¹,Maynard Nick²,Hofstetter W¹⁰,Ferri Lorenzo¹⁹,Berge Henegouwen Mark I.¹⁴,Markar Sheraz R.²²⁰,

Affiliation:

1. Academic Surgical Unit, Department of Surgery and Cancer, Imperial College London, St Mary’s Hospital, London, UK

2. Department of Surgery, Churchill Hospital, Oxford University Hospitals NHS Trust, Old Road, Oxford, OX3 7LE, UK

3. The Ludwig Institute for Cancer Research, University of Oxford, Old Road Campus Research Building Roosevelt Drive, Oxford, OX3 7DQ, UK

4. Department of Surgery, Birmingham University Hospitals NHS Foundation Trust, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK

5. General Gastric and Esophagus Surgery Unit, Humanitas Research Hospital, Italy

6. Esophageal and endocrine surgery unit, digestive surgery department, centre Magellan, CHU de Bordeaux, France

7. Stomach and Oesophageal Tumor Centre, Comprehensive Cancer Center, University Hospital Zuric, Zurich, Switzerland

8. Department of Digestive and General Surgery, University Hospital Claude Huriez, Lille, Cedex, France

9. Oncological Surgery Unit, Veneto Institute of Oncology, IOV – IRCCS, Padua, Italy

10. University of Texas, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 445, Houston, TX, United States

11. Department of Surgery, University Medical Centre, Johannes Gutenberg University Mainz. Mainz, Germany

12. Department of Thoracic Surgery and Thoracic Oncology, Virginia Mason Hospital & Seattle Medical Center, 1100 Ninth Avenue, Seattle, WA 98101

13. Department of Surgery, Guy’s and St Thomas’ Hospitals NHS Foundation Trust, Westminster Bridge Road, London SE1 7EH, UK

14. Department of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, the Netherlands

15. Department of Upper Gastrointestinal Surgery, University Medical Center Utrecht, Netherlands

16. Department of Thoracic Surgery, Diseases of the Esophagus & Lung Transplantations. Chemin des Bourrely, North Hospital, Marseille, France

17. Northern Esophago-Gastric Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Freeman Road, Newcastle upon Tyne, NE7 7DN, UK

18. Department of GI Surgery, San Raffaele Hospital, Milan, Italy

19. Departments of Surgery and Oncology, McGill University, Montreal General Hospital, Cedar Avenue, Montreal, Canada

20. Nuffield Department of Surgery, University of Oxford, UK

Abstract

Background: Chemoradiotherapy (CRT) is a core component of multimodality treatment for locally advanced esophageal cancer. The timing of surgery following CRT may influence the probability of performing an oncological resection and the associated operative morbidity. Objective: To determine the impact of delayed surgical intervention following CRT on survival from esophageal cancer. Methods: This was an international, multi-center, cohort study, including patients from seventeen centers who received CRT followed by surgery between 2010-2020. In the main analysis patients were divided into four groups based upon the interval between chemoradiotherapy and surgery (0-50, 51-100, 101-200 and >200 d) to assess the impact upon 90-day mortality and 5-year overall survival (OS). Multivariable logistic and Cox regression provided hazard rations (HRs) with 95% confidence intervals (95%CI) adjusted for relevant patient, oncological and pathological confounding factors. Results: 2,867 patients who underwent esophagectomy after CRT were included. After adjustment for relevant confounders, prolonged interval following CRT was associated with an increased 90-day mortality compared to 0-50 days (reference): 51-100 days (HR=1.54, 95%CI 1.04-2.29), 101-200 days (HR=2.14, 95%CI 1.37-3.35) and >200 days (HR=3.06, 95%CI 1.64-5.69). Similarly, a poorer 5-year OS was also observed with prolonged interval following CRT compared to 0-50 days (reference): 101-200 days (HR=1.41, 95%CI 1.17-1.70) and >200 days (HR=1.64, 95%CI 1.24-2.17). Conclusion: Prolonged interval following CRT before esophagectomy is associated with increased 90-day mortality and poorer long-term survival. Further investigation is needed to understand the mechanism that underpins these adverse outcomes observed with a prolonged interval to surgery.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Surgery