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Ann Surg. 2014 Nov;260(5):764-70; discussion 770-1. doi: 10.1097/SLA.0000000000000955.

Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection: results of a European multicenter study.

Author information

1
*Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France †North of France University, Lille, France ‡Inserm, UMR837, Team 5 "Mucines Epithelial Differentiation and Carcinogenesis," JPARC, Lille, France §SIRIC OncoLille, France ¶Department of Biostatistics, University Hospital, Lille, France ‖Department of Digestive Surgery of Croix-Rousse University Hospital, Lyon, France **Cavale Blanche University Hospital, Brest, France ††Purpan University Hospital, Toulouse, France ‡‡Saint Antoine University Hospital, Paris, France §§Hautepierre University Hospital, Strasbourg, France ¶¶Pitié-Salpétrière University Hospital, Paris, France ‖‖Edouard Herriot University Hospital, Lyon, France ***Louis Mourier University Hospital, Colombes, France †††Vaudois University Hospital, Lausanne, Switzerland ‡‡‡ULB-Erasme-Bordet University Hospital, Bruxelles, Belgium §§§Pontchaillou University Hospital, Rennes, France ¶¶¶Haut-Levêque University Hospital, Bordeaux, France.

Abstract

OBJECTIVES:

To assess the impact of neoadjuvant chemoradiotherapy (NCRT) on anastomotic leakage (AL) and other postoperative outcomes after esophageal cancer (EC) resection.

BACKGROUND:

Conflicting data have emerged from randomized studies regarding the impact of NCRT on AL.

METHODS:

Among 2944 consecutive patients operated on for EC between 2000 and 2010 in 30 European centers, patients treated by NCRT after surgery (n=593) were compared with those treated by primary surgery (n=1487). Multivariable analyses and propensity score matching were used to compensate for the differences in some baseline characteristics.

RESULTS:

Patients in the NCRT group were younger, with a higher prevalence of male sex, malnutrition, advanced tumor stage, squamous cell carcinoma, and surgery after 2005 when compared with the primary surgery group. Postoperative AL rates were 8.8% versus 10.6% (P=0.220), and 90-day postoperative mortality and morbidity rates were 9.3% versus 7.2% (P=0.110) and 33.4% versus 32.1% (P=0.564), respectively. Pulmonary complication rates did not differ between groups (24.6% vs 22.5%; P=0.291), whereas chylothorax (2.5% vs 1.2%; P=0.020), cardiovascular complications (8.6% vs 0.1%; P=0.037), and thromboembolic events (8.6% vs 6.0%; P=0.037) were higher in the NCRT group. After propensity score matching, AL rates were 8.8% versus 11.3% (P=0.228), with more chylothorax (2.5% vs 0.7%; P=0.030) and trend toward more cardiovascular and thromboembolic events in the NCRT group (P=0.069). Predictors of AL were high American Society of Anesthesiologists scores, supracarinal tumoral location, and cervical anastomosis, but not NCRT.

CONCLUSIONS:

Neoadjuvant chemoradiotherapy does not have an impact on the AL rate after EC resection (NCT 01927016).

PMID:
25379847
DOI:
10.1097/SLA.0000000000000955
[Indexed for MEDLINE]

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