• Urs von Holzen, Sven Schmidt, Stefanie Hayoz, Thomas Steffen, Felix Grieder, Detlef Bartsch, Annelies Schnider, Wolfram-Trudo Knoefel, Guillaume Piessen, Christoph Kettelhack, Walter R Marti, Markus Schäfer, Reinhold Függer, Alfred Köigsrainer, Beat Gloor, Markus Furrer, Marie-Aline Gérard, Hanne Hawle, Martin K Walz, Piero Alesina, Thomas Ruhstaller, and Swiss Group for Clinical Cancer Research (SAKK), the German Esophageal Cancer Study Group, the Austrian Arbeitsgemeinschaft Medikamentöse Tumortherapie (AGMT), the Fédération Francophone de Cancérologie Digestive (FFCD)/Fédération de Recherche en Chirurgi.
• University Hospital Basel, Basel, Switzerland Universitätsspital, Basel, Switzerland.
• Ann. Surg. 2022 Jun 1; 275 (6): 1130-1136.

ObjectiveTo assess the impact of surgical technique in regard to morbidity and mortality after neoadjuvant treatment for esophageal cancer.BackgroundThe SAKK trial 75/08 was a multicenter phase III trial (NCT01107639) comparing induction chemotherapy followed by chemoradiation and surgery in patients with locally advanced esophageal cancer.MethodsPatients in the control arm received induction chemotherapy with cisplatin and docetaxel, followed by concomitant chemoradiation therapy with cisplatin, docetaxel, and 45Gy. In the experimental arm, the same regimen was used with addition of cetuximab. After completion of neoadjuvant treatment, patients underwent esophagectomy. The experimental arm received adjuvant cetuximab. Surgical outcomes and complications were prospectively recorded and analyzed.ResultsTotal of 259 patients underwent esophagectomy. Overall complication rate was 56% and reoperation rate was 15% with no difference in complication rates for transthoracic versus transhiatal resections (56% vs 54%, P = 0.77), nor for video assisted thoracic surgeries (VATS) versus open transthoracic resections (67% vs 55%, P = 0.32). There was a trend to higher overall complication rates in squamous cell carcinoma versus adenocarcinoma (65% vs 51%, P = 0.035), and a significant difference in ARDS in squamous cell carcinoma with 14% versus 2% in adenocarcinoma (P = 0.0002). For patients with involved lymph nodes, a lymph node ratio of ≥0.1 was an independent predictor of PFS (HR 2.5, P = 0.01) and OS (HR 2.2, P = 0.03).ConclusionsThis trial showed no difference in surgical complication rates between transthoracic and transhiatal resections. For patients with involved lymph nodes, lymph node ratio was an independent predictor of progression free survival and overall survival.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

21 keywords...

hide…