title: Induction chemoradiotherapy increases pleural and pericardial complications after esophagectomy for cancer.
abstract: OBJECTIVE
  Limited information is available on late complications of multimodality therapy for locally advanced esophageal cancer. This study focuses on postesophagectomy benign pleural and pericardial complications to determine their prevalence, temporal pattern, and treatment, and their association with induction chemoradiotherapy and influence on survival.
  
  
  METHODS
  Between March 1987 and November 2001, 291 patients with clinical stage > or = IIA esophageal cancer underwent esophagectomy; 106 received induction chemoradiotherapy. A propensity score incorporating clinical stage and histopathology was used to identify 100 matched pairs of induction chemoradiotherapy and surgery-only patients. Among these, occurrence of pleural effusion, pericardial effusion, and pericarditis was ascertained by follow-up. Time-related occurrence, risk factors, and association with survival were assessed by repeated-events analyses.
  
  
  RESULTS
  During follow-up, 61 induction chemoradiotherapy patients experienced at least one pleural or pericardial complication, as did 46 propensity-matched surgery-only patients. Most occurred within 1 year, with 1-year freedom from occurrence only 34% after induction chemoradiotherapy and 59% after surgery only (p = 0.02). Risk of pleural effusion was nearly twice as great (hazard ratio 1.7, p = 0.0004) and pericardial complications 5 times greater (hazard ratio 5.3, p = 0.0005) after induction chemoradiotherapy than after surgery alone. Complications after induction chemoradiotherapy required intervention somewhat more frequently (58% versus 47%, p = 0.18), although they did not diminish subsequent survival (p > 0.8).
  
  
  CONCLUSIONS
  Benign pleural and pericardial complications occur surprisingly frequently after esophagectomy, particularly when induction chemoradiotherapy is employed. This must be factored into discussions of morbidity for multimodality treatment strategies for locally advanced esophageal cancer and should be considered distinct from acute toxicity of induction chemoradiotherapy reported.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA. murthys1@ccf.org
authors.forename: Sudish C
authors.initials: SC
authors.lastname: Murthy
authors.forename: Maria Solovera
authors.initials: MS
authors.lastname: Rozas
authors.forename: David J
authors.initials: DJ
authors.lastname: Adelstein
authors.forename: David P
authors.initials: DP
authors.lastname: Mason
authors.forename: Royce
authors.initials: R
authors.lastname: Calhoun
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Rybicki
authors.forename: Jingyuan
authors.initials: J
authors.lastname: Feng
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Rice
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010493:Pericarditis / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D010996:Pleural Effusion / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012016:Reference Values; D012074:Remission Induction; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome