397. NEOADJUVANT CHEMORADIOTHERAPY VERSUS NEOADJUVANT CHEMOTHERAPY AND POSTOPERATIVE COMPLICATIONS AFTER ESOPHAGECTOMY FOR CANCER

Abstract

Abstract Postoperative complications after esophagectomy are common. Neoadjuvant chemotherapy or chemoradiotherapy in addition to surgery is the standard treatment with curative intent for patients with locally advanced esophageal cancer. The aims of our study were to analyze if the addition of neoadjuvant radiotherapy to chemotherapy and surgery increases the rate and severity of postoperative complications and to evaluate if radiotherapy doses to the heart and lungs were associated with postoperative complications. The study was based on a prospectively collected database of esophageal cancer patients that were operated on between October 2008 and March 2020. Patients treated with neoadjuvant chemoradiotherapy were compared to patients treated with neoadjuvant chemotherapy. All postoperative complications were graded according to the Clavien Dindo classification. The primary outcome was 30-day postoperative complications. Logistic regression was used to determine the effect of radiotherapy on complication rates. Several dose/volume parameters for the lungs and the heart were considered. During the study period esophagectomy was performed on 275 patients after neoadjuvant treatment (93 after chemotherapy and 182 after chemoradiotherapy). The median total radiation dose was 41.4 Gy, the median lung dose was 6.2 Gy and the median dose to the heart was 20.3 Gy. Neoadjuvant chemoradiotherapy compared to chemotherapy showed no association with postoperative complications of a Clavien Dindo score of ≥2 or severe postoperative complications (Clavien Dindo ≥3b). Taxane-containing chemotherapy had a statistically significant association with postoperative complications (table 1). The radiotherapy dose to the heart and lungs had no significant association with postoperative complications. In our cohort, the addition of preoperative radiotherapy to chemotherapy did not increase the rate of postoperative complications. However, an association between postoperative complications and taxane-containing chemotherapy regimens given with or without concomitant radiotherapy was noted.