• Swathikan Chidambaram, Richard Owen, Bruno Sgromo, Magdalena Chmura, Aaron Kisiel, Richard Evans, Ewen A Griffiths, Carlo Castoro, Caroline Gronnier, Mometo Ali MaoAwyes, Christian A Gutschow, Guillaume Piessen, Sébastien Degisors, Rita Alvieri, Hope Feldman, Giovanni Capovilla, Peter P Grimminger, Shiwei Han, Donald E Low, Jonathan Moore, James Gossage, Dan Voeten, Suzanne S Gisbertz, Jelle Ruurda, Richard van Hillegersberg, Xavier B D'Journo, Jakub Chmelo, Alexander W Phillips, Riccardo Rosati, George B Hanna, Nick Maynard, Wayne Hofstetter, Lorenzo Ferri, Mark I Berge Henegouwen, and Sheraz R Markar.
• Academic Surgical Unit, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
• Ann. Surg. 2023 Nov 1; 278 (5): 701708701-708.

ObjectiveTo determine the impact of delayed surgical intervention following chemoradiotherapy (CRT) on survival from esophageal cancer.BackgroundCRT is a core component of multimodality treatment for locally advanced esophageal cancer. The timing of surgery following CRT may influence the probability of performing an oncological resection and the associated operative morbidity.MethodsThis was an international, multicenter, cohort study, including patients from 17 centers who received CRT followed by surgery between 2010 and 2020. In the main analysis, patients were divided into 4 groups based upon the interval between CRT and surgery (0-50, 51-100, 101-200, and >200 days) to assess the impact upon 90-day mortality and 5-year overall survival. Multivariable logistic and Cox regression provided hazard ratios (HRs) with 95% CIs adjusted for relevant patient, oncological, and pathologic confounding factors.ResultsA total of 2867 patients who underwent esophagectomy after CRT were included. After adjustment for relevant confounders, prolonged interval following CRT was associated with an increased 90-day mortality compared with 0 to 50 days (reference): 51 to 100 days (HR=1.54, 95% CI: 1.04-2.29), 101 to 200 days (HR=2.14, 95% CI: 1.37-3.35), and >200 days (HR=3.06, 95% CI: 1.64-5.69). Similarly, a poorer 5-year overall survival was also observed with prolonged interval following CRT compared with 0 to 50 days (reference): 101 to 200 days (HR=1.41, 95% CI: 1.17-1.70), and >200 days (HR=1.64, 95% CI: 1.24-2.17).ConclusionsProlonged interval following CRT before esophagectomy is associated with increased 90-day mortality and poorer long-term survival. Further investigation is needed to understand the mechanism that underpins these adverse outcomes observed with a prolonged interval to surgery.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

21 keywords...

hide…