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Esophagectomy after definitive chemoradiation in esophageal cancer: a safe therapeutic strategy.
van Geffen, Eline G M; Neelis, Karen J; Putter, Hein; Slingerland, Marije; de Steur, Wobbe O; van der Kraan, Jolein; van der Molen, Aart J; Crobach, A Stijn L P; Hartgrink, Henk H.
Afiliación
  • van Geffen EGM; Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
  • Neelis KJ; Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands.
  • Putter H; Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.
  • Slingerland M; Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
  • de Steur WO; Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
  • van der Kraan J; Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands.
  • van der Molen AJ; Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
  • Crobach ASLP; Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands.
  • Hartgrink HH; Department of Surgical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
Dis Esophagus ; 37(11)2024 Oct 28.
Article en En | MEDLINE | ID: mdl-39110921
ABSTRACT
The standard treatment regimen for esophageal cancer is chemoradiation followed by esophagectomy. However, the use of neoadjuvant chemoradiotherapy damages the surrounding tissue, which potentially increases the risk of postoperative complications, including anastomotic leakage. The impact of definitive chemoradiotherapy (dCRT, 50.4 Gy radiotherapy) compared to the standard neoadjuvant scheme (nCRT, 41.4 Gy radiotherapy) prior to surgery on the incidence of anastomotic leakage remains poorly understood. To study this, all patients who received dCRT between 2011 and 2021 followed by esophagectomy were included. For each patient, two patients who received nCRT were selected as matched controls. Outcomes included postoperative anastomotic leakage, pulmonary and other complications, anastomotic stenosis, pulmonary and other postoperative complications (Clavien Dindo Classification ≥1), and overall survival. One hundred and eight patients were included with a median follow-up of 28 months. The time between neoadjuvant treatment and surgery was longer in the dCRT group compared to the nCRT group (65 vs. 48 days, P < 0.001). Postoperatively, significantly more patients in the dCRT group suffered from anastomotic leakage (11% vs. 1%, P = 0.04) and anastomotic stenosis (42% vs. 17%, P < 0.01). No differences were found for other complications or overall survival between both groups. In conclusion, preoperative dCRT is associated with a higher risk of anastomotic leakage and stenosis. These complications, however, can be treated effectively. Therefore, esophagectomy after dCRT is considered to be an appropriate treatment strategy in a selected patient group.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Esofágicas / Esofagectomía / Terapia Neoadyuvante / Fuga Anastomótica / Quimioradioterapia Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Dis Esophagus Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Esofágicas / Esofagectomía / Terapia Neoadyuvante / Fuga Anastomótica / Quimioradioterapia Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Dis Esophagus Asunto de la revista: GASTROENTEROLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Países Bajos Pais de publicación: Estados Unidos