672P - Effects of Neoadjuvant Chemoradiotherapy on Postoperative Morbidity and Mortality Associated with Esophageal Cancer

Abstract

ABSTRACT Background The results of clinical trials and meta-analyses suggest that neoadjuvant chemoradiotherapy (CRT) followed by esophagectomy confers a survival benefit upon patients with locally advanced esophageal cancer compared with esophagectomy alone. However, whether neoadjuvant CRT increases the risk of postoperative morbidity and mortality remains controversial. Methods Data from 206 patients who underwent transthoracic esophagectomy with gastric tube reconstruction and cervical anastomosis between May 2003 and October 2011 were reviewed. Neoadjuvant CRT comprised 40 Gy of radiation and concurrent chemotherapy with 5FU plus one of docetaxel, cisplatin or combined docetaxel/cisplatin. We compared the surgical outcomes of 114 patients (55%) who underwent esophagectomy alone (group 1) and 92 (45%) who received neoadjuvant CRT followed by esophagectomy (group 2). We also assessed preoperative factors that influence postoperative major morbidity including anastomotic leak, graft necrosis, multilobar pneumonia, empyema, chylothorax and recurrent nerve palsy with tracheotomy. Results The operative duration, blood loss and overall postoperative morbidity rates were 403 ± 79 and 421 ± 76 min (p = 0.10), 560 ± 407 and 589 ± 446 mL (p = 0.62) and 45% and 55% (p = 0.13) in groups 1 and 2, respectively. Rates of anastomotic leak (8.8 vs. 14.1%; p = 0.23), pneumonia (8.8 vs.13.0%; p = 0.32), recurrent nerve palsy (14.9 vs.9.8%; p = 0.27) and all other complications did not significantly differ between the groups. The 30-day mortality rate was 0% in each group and hospital mortality rates were 0.9 and 1.0% in groups 1 and 2, respectively (p = 0.88). Univariate analysis of preoperative factors indicated that advanced age, a history of cardiovascular disease, a high serum creatinine and advanced tumor stage were significantly associated with postoperative major morbidity, whereas neoadjuvant CRT was unrelated to the incidence of major morbidity. Multivariable analysis revealed cardiovascular disease (Odds ratio, 2.46; 95%CI, 1.27 - 4.78; p = 0.008) and advanced tumor stage (Odds ratio, 2.24; 95%CI, 1.15 - 4.35; p = 0.017) as independent covariates for major morbidity. Conclusion Neoadjuvant CRT is safe and does not increase the incidence of postoperative morbidity and mortality compared with esophagectomy alone. Disclosure All authors have declared no conflicts of interest.