Abstract
BackgroundNeoadjuvant chemoradiation might increase anastomotic leakage and stenosis in patients with esophageal cancer treated with neoadjuvant chemoradiation and esophagectomy. The aim of this study was to determine the influence of radiation dose on the incidence of leakage and stenosis.MethodsFifty-three patients with esophageal cancer received neoadjuvant chemoradiation (23 × 1.8 Gy) (combined with Paclitaxel and Carboplatin) followed by a transhiatal esophagectomy between 2009 and 2011. On planning CT, the future anastomotic region was determined and the mean radiation dose, V20, V25, V30, V35 and V40 were calculated. Logistic regression analysis was conducted to examine determinants of anastomotic leakage and stenosis.ResultsAnastomotic leaks occurred in 13 of 53 patients (25.5%) and anastomotic stenosis occurred in 24 of 53 patients (45.3%). Median follow-up was 20 months. Logistic regression analysis showed that mean dose, V20-V40, age, co-morbidity, method of anastomosis, operating time and interval between last radiotherapy treatment and surgery were not predictors of anastomotic leakage and stenosis.ConclusionsA radiation dose of 23 × 1.8 Gy on the future anastomotic region has no influence on the occurrence of anastomotic leakage and stenosis in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by transhiatal esophagectomy.
Highlights
Neoadjuvant chemoradiation might increase anastomotic leakage and stenosis in patients with esophageal cancer treated with neoadjuvant chemoradiation and esophagectomy
According to the current Dutch guidelines, the preferred curative treatment for non-metastatic disease is neoadjuvant chemoradiation followed by transhiatal or transthoracic esophagectomy [3]
All 53 patients completed the neoadjuvant chemoradiation regimen followed by transhiatal esophagectomy after a therapy free interval of 4–18 weeks, with a median of 9 weeks
Summary
Neoadjuvant chemoradiation might increase anastomotic leakage and stenosis in patients with esophageal cancer treated with neoadjuvant chemoradiation and esophagectomy. The aim of this study was to determine the influence of radiation dose on the incidence of leakage and stenosis. Pulmonary complications and anastomotic complications like leakage and stenosis are still common [7,8,9]. The incidence of anastomotic leakage reported in the literature ranges from 5.7% to 41% [6,7,8,9,10,11,12,13,14,15,16]. Incidence rates of anastomotic stenosis are even higher ranging from 21.8% to 44% [6,10,11,12]
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