Timing of Esophagectomy after Neoadjuvant Chemoradiation Therapy Affects the Incidence of Anastomotic Leaks
10.5090/kjtcs.2019.52.1.1
- Author:
Simon ROH
1
;
Mark D IANNETTONI
;
John KEECH
;
Evgeny V ARSHAVA
;
Anthony SWATEK
;
Miriam B ZIMMERMAN
;
Ronald J WEIGEL
;
Kalpaj R PAREKH
Author Information
1. Division of Interventional Radiology, New York Presbyterian Hospital–Weill Cornell Medical Center.
- Publication Type:Original Article
- Keywords:
Esophageal neoplasms;
Esophagectomy;
Anastomotic leak;
Chemoradiotherapy;
Neoadjuvant therapy
- MeSH:
Anastomotic Leak;
Chemoradiotherapy;
Cohort Studies;
Esophageal Neoplasms;
Esophagectomy;
Humans;
Incidence;
Neoadjuvant Therapy;
Retrospective Studies;
Standard of Care
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2019;52(1):1-8
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Neoadjuvant chemoradiation therapy (nCRT) has become the standard of care for esophageal cancer patients prior to esophagectomy. However, the optimal timing for surgery after completion of nCRT remains unclear. METHODS: A retrospective review was performed of patients who underwent esophagectomy with cervical anastomosis for esophageal cancer at a single institution between January 2000 and June 2015. Patients were categorized into 3 cohorts: those who did not receive nCRT prior to esophagectomy (no nCRT), those who underwent esophagectomy within 35 days after nCRT (≤35d), and those who underwent esophagectomy more than 35 days after nCRT (>35d). RESULTS: A total of 366 esophagectomies were performed during the study period, and 348 patients met the inclusion criteria. Anastomotic leaks occurred in 11.8% of all patients included in the study (41 of 348). Within each cohort, anastomotic leaks were detected in 14.7% of patients (17 of 116) in the no nCRT cohort, 7.3% (13 of 177) in the ≤35d cohort, and 20.0% (11 of 55) in the >35d cohort (p=0.020). Significant differences in the occurrence of anastomotic leaks were observed between the no nCRT and ≤35d cohorts (p=0.044), and between the ≤35d and >35d cohorts (p=0.007). CONCLUSION: Esophagectomy with cervical anastomosis within 35 days of nCRT resulted in a lower percentage of anastomotic leaks.
