A. M. Brown1, D. Giugliano1, F. Palazzo1, E. L. Rosato1, N. R. Evans1, C. R. Lamb1, D. A. Levine1, A. C. Berger1 1Thomas Jefferson University,Department Of Surgery,Philadelphia, PA, USA
Introduction:
Neoadjuvant chemoradiation (nCRT) followed by definitive esophagectomy has become a mainstay of treatment for stage two and three esophageal cancer. It has been demonstrated in rectal cancer that a complete response to nCRT is a predictor of anastomotic leak, as well as post-operative morbidity and mortality. We hypothesized that a complete treatment effect after nCRT may negatively affect anastomotic leak rate and post-operative morbidity and mortality.
Methods:
A retrospective review of all patients who underwent esophagectomy following nCRT for esophageal cancer between January 2000, and June 2016 was completed. The patients were stratified by their response to preoperative chemoradiation: no change or upstage (group 1), partial response (group 2), or a complete response (group 3), based on final surgical pathology. The postoperative courses of all patients were reviewed for anastomotic leak, respiratory failure defined as ventilator dependence greater than 48 hours, re-intubation, or acute respiratory distress syndrome (ARDS), as well as any pulmonary complication. All complications were categorized using a modification of the Clavien-Dindo classification. Statistical significance was calculated using a one-sided ANOVA test.
Results:
There were 215 patients who underwent esophagectomy for esophageal cancer. The average age was 61 (range 31 to 84). Open esophagectomy was performed in 91 patients, and 124 underwent minimally invasive esophagectomy. With regards to neoadjuvant treatment, 78 patients (36%) had no change or a pathological upstage, 69 (32%) had a partial response, and 68 (32%) had a complete response. Rates of anastomotic leak were 14.1% in group 1, 8.7% in group 2, and 17.6% in group 3 (p=0.306). Rates of respiratory failure were similar—21.8%, 23.2%, and 23.5% respectively (p=0.965). Grade 3 or higher complication rates were 29.5%, 31.9%, and 30.9% respectively (p=0.952). There were no major differences in the frequency of any pulmonary complication (41.0%, 43.5%, 35.3%, p=0.607), or peri-operative mortality (7.7%, 5.8%, and 7.4% (p=0.895)).
Conclusion:
There are no significant differences in complications and anastomotic leak based on pathologic response to nCRT. Esophagectomy after nCRT is not compromised by a complete pathologic response.