Association of increased time from chemoradiation (CRT) to esophagectomy (E) with increased surgical complications (Cx) in esophageal cancer (EC).

Abstract

77 Background: EC is often treated with CRT followed by E. E is typically performed 6 weeks after completion of CRT, but the optimal timing is unknown. Previous work has shown that a longer time interval (TI) between CRT and E resulted in a higher percentage of patients (pts) with pathologic complete response. This study was undertaken to determine whether this improved response comes at the expense of increased surgical Cx. Methods: Complete records were available for 85 pts who underwent CRT and subsequent E at a single academic center from 2001-2011. Surgical Cx were collected. Univariable and multivariable analyses were performed to investigate the association between length of TI from CRT to E and Cx, adjusting for age, gender, and surgery type. Multiple linear regression was performed to examine the association of length of stay (LOS) and estimated blood loss (EBL) with TI, adjusting for covariates. Results: Of 85 patients, 72 were male and the histology was adenocarcinoma in 72. The median age was 61 (range: 36-80), the most common clinical stage was T3N1 and 60% of pts had ECOG performance status of 1 (range 0-2). The median length of CRT (most commonly Cisplatin, 5FU and 50.4 Gy) was 37 days and median TI from initiation of CRT to E was 89 days (range: 64-242). 59 pts (69%) experienced at least 1 complication. The mean TIs for pts with and without Cx were 97 and 87 days (P=0.019). When specific Cx were examined, the mean TI for pulmonary Cx was greater (107 v. 89 days; P=0.018). Patients experiencing anastamotic leaks had shorter mean TIs (83 v. 96 days; P=0.022). Multiple linear regression showed a positive association between LOS and TI (p=0.0027) but none with EBL. On multivariable analysis, increased TI predicted for pulmonary complications (OR 1.05, P=0.0061) and LOS (OR 1.03, P=0.033). Increased TI predicted for decreased risk of anastamotic leak (OR 0.94, P=0.063). Conclusions: In this retrospective data set, we demonstrated an association between longer TI from CRT to E and pulmonary toxicity in EC pts. Longer TI was also associated with increased LOS. In contrast, anastamotic leaks were associated with shorter TIs. These data suggest TI from CRT to E may impact the risk of Cx.