title: Influence of preoperative chemotherapy for advanced thoracic oesophageal squamous cell carcinoma on perioperative complications.
abstract: BACKGROUND
  The Japan Clinical Oncology Group (JCOG) 9907 trial has changed the standard of care for advanced thoracic oesophageal cancer in Japan from postoperative chemotherapy to preoperative chemotherapy. The impact of preoperative chemotherapy on the risk of developing postoperative complications remains controversial. This article reports the safety analysis of JCOG9907, focusing on risk factors for postoperative complications.
  
  
  METHODS
  Patients with potentially resectable advanced thoracic oesophageal squamous cell carcinoma were randomized to either postoperative or preoperative chemotherapy followed by transthoracic oesophagectomy with D2-3 lymphadenectomy. Chemotherapy consisted of two cycles of cisplatin and 5-fluorouracil. Clinical baseline data, intraoperative complications, postoperative complications and in-hospital mortality, collected on the case report forms in a predetermined format, were analysed. Univariable and multivariable analyses were used to explore the risk of postoperative complications in relation to treatment group, age, sex, tumour depth, nodal metastasis, stage and location.
  
  
  RESULTS
  Of 330 patients randomized, 166 were assigned to receive postoperative chemotherapy and 164 preoperative chemotherapy; 162 and 154 patients respectively underwent surgery. The incidence of intraoperative complications, postoperative complications and in-hospital mortality was similarly low in both groups. Multivariable analysis showed that age, sex and tumour location were independently associated with an increase in postoperative complications, but preoperative chemotherapy was not.
  
  
  CONCLUSIONS
  Preoperative chemotherapy does not increase the risk of complications or hospital mortality after surgery for advanced thoracic oesophageal cancer.
authors.affiliation: Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan. hiraom@onh.go.jp
authors.forename: M
authors.initials: M
authors.lastname: Hirao
authors.forename: N
authors.initials: N
authors.lastname: Ando
authors.forename: T
authors.initials: T
authors.lastname: Tsujinaka
authors.forename: H
authors.initials: H
authors.lastname: Udagawa
authors.forename: M
authors.initials: M
authors.lastname: Yano
authors.forename: H
authors.initials: H
authors.lastname: Yamana
authors.forename: K
authors.initials: K
authors.lastname: Nagai
authors.forename: J
authors.initials: J
authors.lastname: Mizusawa
authors.forename: K
authors.initials: K
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy / Q000379:methods; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016629:Esophagectomy / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008197:Lymph Node Excision / Q000379:methods; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care / Q000379:methods; D012307:Risk Factors; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome