Abstract
Abstract The optimal time interval from neoadjuvant therapy to surgery for esophageal cancer still remains unclear and controversial. Our aims were to investigate if prolonged time to surgery would have an impact on pathological complete response (pCR) rates and postoperative complications, and affect the survival for locally advanced esophageal squamous cancer (ESCC). Patients with locally advanced ESCC receiving neoadjuvant chemoradiotherapy followed by esophagectomy between June 2017 and December 2020 were prospectively enrolled and retrospectively analyzed. Patients were divided into two groups, timely and delayed surgery groups, namely, group A (< 10 weeks) and group B (≥ 10 weeks). We further classified the patients according to interval quartiles and 3-week groups. We measured the tumor regression score (TRS), pathological complete regression (pCR), clinical complete regression (cCR), overall survival (OS), progression-free survival (PFS) and postoperative complications as the analytical outcomes for this study. A total of 40 patients (34.5%) in the timely surgery group (n = 116) and 54 patients (50.0%) in the delayed surgery group (n = 108) achieved pCR (P = 0.019). The postoperative complications and survival for two groups were similar. However, for patients with a non-cCR, delayed surgery was associated with poor survival (P = 0.035) and cancer progression (P = 0.036). For the second step of analysis, using linear-by-linear association chi-square test, the pCR rates were significantly difference across 4 groups and were increased along with time interval (P = 0.006). Results for 3-week intervals were similar (P = 0.009). Patients with prolonged time interval (up to 12 weeks) from neoadjuvant chemoradiation to surgery have higher pCR rates without an impact on operative morbidity. For patients who have a non-cCR to neoadjuvant chemoradiation, delayed surgery was associated with poor survival and surgery should be performed within 10 weeks after neoadjuvant chemoradiation.
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