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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.

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*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.



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


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


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.


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.


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

[Indexed for MEDLINE]

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