Verification of the Optimal Interval Before Esophagectomy After Preoperative Neoadjuvant Chemoradiotherapy for Locally Advanced Thoracic Esophageal Cancer
Verification of the Optimal Interval Before Esophagectomy After Preoperative Neoadjuvant Chemoradiotherapy for Locally Advanced Thoracic Esophageal Cancer
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DOI：
10.1245/s10434-020-09206-x
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发表时间：
2020-10-13
影响因子：
3.7
通讯作者：
Minamiya, Yoshihiro
中科院分区：
文献类型：
--
作者：
Wakita, Akiyuki;Motoyama, Satoru;Minamiya, Yoshihiro
据报道，术前放化疗和手术之间的间隔时间会影响围手术期结局和生存率;然而，食管癌患者的最佳间隔时间仍不确定。目的探讨术前新辅助放化疗（NACRT）与食管癌切除术间隔时间的延长对食管癌患者预后的影响。方法2009年至2017年期间，共有131例食管癌患者在秋田大学医院接受NACRT后接受了根治性手术。我们根据从NACRT到食管切除术的中位时间将这些患者分为两组，并比较病理完全缓解（pCR）率、手术结局和生存率。结果NACRT至食管切除术的中位间隔时间为39天（21-95天）。在131例患者中，70例（53%）在完成NACRT后39天或更长时间后接受食管切除术。两组之间的临床病理学特征（包括pCR率）无显著差异。从NACRT到食管切除术的间隔时间延长与吻合口瘘和喉返神经麻痹的发生率增加显著相关（分别为p = 0.0225和p = 0.0022）;然而，未检测到与总生存率相关。结论NACRT和食管切除术之间的间隔时间延长对pCR率或生存率没有影响。然而，延迟食管切除术可能会增加手术并发症的可能性，如吻合口瘘和喉返神经麻痹。
Background The interval between preoperative chemoradiotherapy and surgery reportedly affects perioperative outcomes and survival; however, the optimal interval in esophageal cancer patients remains uncertain. Objective Our aim was to determine whether a prolonged interval between preoperative neoadjuvant chemoradiotherapy (NACRT) and esophagectomy affects the outcomes of esophageal cancer patients. Methods A total of 131 patients with esophageal cancer received curative surgery following NACRT at Akita University Hospital between 2009 and 2017. We divided these patients into two groups based on the median interval from NACRT to esophagectomy, and compared the rates of pathological complete response (pCR), surgical outcomes, and survival. Results The median interval from NACRT to esophagectomy was 39 days (range 21-95). Of the 131 patients, 70 (53%) received esophagectomy after 39 days or more from completion of NACRT. There were no significant differences in the clinicopathological features, including pCR rates, between the two groups. Prolongation of the interval from NACRT to esophagectomy was significantly associated with an increased rate of anastomotic leakage and recurrent laryngeal nerve palsy (p = 0.0225 andp = 0.0022, respectively); however, no association with overall survival was detected. Conclusions A prolonged interval between NACRT and esophagectomy had no impact on pCR rates or survival. However, delaying esophagectomy may increase the likelihood of surgical complications such as anastomotic leakage and recurrent laryngeal nerve palsy.