title: Does the timing of esophagectomy after chemoradiation affect outcome?
abstract: BACKGROUND
  After neoadjuvant chemoradiation (CXRT) for esophageal cancer, surgery has traditionally been recommended to be performed within 8 weeks. However, surgery is often delayed for various reasons. Data from other cancers suggest that delaying surgery may increase the pathologic complete response rate. However, there are theoretical concerns that waiting longer after radiation may lead to a more difficult operation and more complications. The optimal timing of esophagectomy after CXRT is unknown.
  
  
  METHODS
  From a prospective database, we analyzed 266 patients with resected esophageal cancer who were treated with neoadjuvant CXRT from 2002 to 2008. Salvage resections were excluded from this analysis. We compared patients who had surgery within 8 weeks of CXRT and those who had surgery after 8 weeks. We used multivariable analysis to determine whether increased interval between chemoradiation and surgery was independently associated with perioperative complication, pathologic response, or overall survival.
  
  
  RESULTS
  One hundred fifty patients were resected within 8 weeks and 116 were resected greater than 8 weeks after completing CXRT. Mean length of operation, intraoperative blood loss, anastomotic leak rate, and perioperative complication rate were similar for the two groups. Pathologic complete response rate and overall survival were also similar for the two groups (p=not significant). In multivariable analysis, timing of surgery was not an independent predictor of perioperative complication, pathologic complete response, or overall survival.
  
  
  CONCLUSIONS
  The timing of esophagectomy after neoadjuvant CXRT is not associated with perioperative complication, pathologic response, or overall survival. It may be reasonable to delay esophagectomy beyond 8 weeks for patients who have not yet recovered from chemoradiation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. jaekim@post.harvard.edu
authors.forename: Jae Y
authors.initials: JY
authors.lastname: Kim
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
authors.forename: David C
authors.initials: DC
authors.lastname: Rice
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Dipen M
authors.initials: DM
authors.lastname: Maru
authors.forename: Manoop S
authors.initials: MS
authors.lastname: Bhutani
authors.forename: James
authors.initials: J
authors.lastname: Welsh
authors.forename: Edith M
authors.initials: EM
authors.lastname: Marom
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Wayne L
authors.initials: WL
authors.lastname: Hofstetter
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome