Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection: results of a European multicenter study.
OBJECTIVE
To assess the impact of neoadjuvant chemoradiotherapy (NCRT) on anastomotic leakage (AL) and other postoperative outcomes after esophageal cancer (EC) resection.


BACKGROUND
Conflicting data have emerged from randomized studies regarding the impact of NCRT on AL.


METHODS
Among 2944 consecutive patients operated on for EC between 2000 and 2010 in 30 European centers, patients treated by NCRT after surgery (n=593) were compared with those treated by primary surgery (n=1487). Multivariable analyses and propensity score matching were used to compensate for the differences in some baseline characteristics.


RESULTS
Patients in the NCRT group were younger, with a higher prevalence of male sex, malnutrition, advanced tumor stage, squamous cell carcinoma, and surgery after 2005 when compared with the primary surgery group. Postoperative AL rates were 8.8% versus 10.6% (P=0.220), and 90-day postoperative mortality and morbidity rates were 9.3% versus 7.2% (P=0.110) and 33.4% versus 32.1% (P=0.564), respectively. Pulmonary complication rates did not differ between groups (24.6% vs 22.5%; P=0.291), whereas chylothorax (2.5% vs 1.2%; P=0.020), cardiovascular complications (8.6% vs 0.1%; P=0.037), and thromboembolic events (8.6% vs 6.0%; P=0.037) were higher in the NCRT group. After propensity score matching, AL rates were 8.8% versus 11.3% (P=0.228), with more chylothorax (2.5% vs 0.7%; P=0.030) and trend toward more cardiovascular and thromboembolic events in the NCRT group (P=0.069). Predictors of AL were high American Society of Anesthesiologists scores, supracarinal tumoral location, and cervical anastomosis, but not NCRT.


CONCLUSIONS
Neoadjuvant chemoradiotherapy does not have an impact on the AL rate after EC resection (NCT 01927016).
*Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France †North of France University, Lille, France ‡Inserm, UMR837, Team 5 "Mucines Epithelial Differentiation and Carcinogenesis," JPARC, Lille, France §SIRIC OncoLille, France ¶Department of Biostatistics, University Hospital, Lille, France ‖Department of Digestive Surgery of Croix-Rousse University Hospital, Lyon, France **Cavale Blanche University Hospital, Brest, France ††Purpan University Hospital, Toulouse, France ‡‡Saint Antoine University Hospital, Paris, France §§Hautepierre University Hospital, Strasbourg, France ¶¶Pitié-Salpétrière University Hospital, Paris, France ‖‖Edouard Herriot University Hospital, Lyon, France ***Louis Mourier University Hospital, Colombes, France †††Vaudois University Hospital, Lausanne, Switzerland ‡‡‡ULB-Erasme-Bordet University Hospital, Bruxelles, Belgium §§§Pontchaillou University Hospital, Rennes, France ¶¶¶Haut-Levêque University Hospital, Bordeaux, France.
Caroline
C
Gronnier
Boris
B
Tréchot
Alain
A
Duhamel
Jean-Yves
JY
Mabrut
Jean-Pierre
JP
Bail
Nicolas
N
Carrere
Jérémie H
JH
Lefevre
Cécile
C
Brigand
Jean-Christophe
JC
Vaillant
Mustapha
M
Adham
Simon
S
Msika
Nicolas
N
Demartines
Issam
I
El Nakadi
Guillaume
G
Piessen
Bernard
B
Meunier
Denis
D
Collet
Christophe
C
Mariette
Guillaume
G
Luc
Magalie
M
Cabau
Jacques
J
Jougon
Bogdan
B
Badic
Patrick
P
Lozach
Serge
S
Cappeliez
Gil
G
Lebreton
Arnaud
A
Alves
Renaud
R
Flamein
Denis
D
Pezet
Federica
F
Pipitone
Bogdan Stan
BS
Iuga
Nicolas
N
Contival
Eric
E
Pappalardo
Styliani
S
Mantziari
Flora
F
Hec
Marguerite
M
Vanderbeken
Williams
W
Tessier
Nicolas
N
Briez
Fabien
F
Fredon
Alain
A
Gainant
Muriel
M
Mathonnet
Jean-Marc
JM
Bigourdan
Salim
S
Mezoughi
Christian
C
Ducerf
Jacques
J
Baulieux
Arnaud
A
Pasquer
Oussama
O
Baraket
Gilles
G
Poncet
Delphine
D
Vaudoyer
Jourdan
J
Enfer
Laurent
L
Villeneuve
Olivier
O
Glehen
Thibault
T
Coste
Jean Michel
JM
Fabre
Frédéric
F
Marchal
Romain
R
Frisoni
Ahmet
A
Ayav
Laurent
L
Brunaud
Laurent
L
Bresler
Charlotte
C
Cohen
Olivier
O
Aze
Nicolas
N
Venissac
Daniel
D
Pop
Jérôme
J
Mouroux
Ion
I
Donici
Michel
M
Prudhomme
Emanuele
E
Felli
Stéphanie
S
Lisunfui
Marie
M
Seman
Gaelle Godiris
GG
Petit
Mehdi
M
Karoui
Christophe
C
Tresallet
Fabrice
F
Ménégaux
Laurent
L
Hannoun
Brice
B
Malgras
Denis
D
Lantuas
Karine
K
Pautrat
Marc
M
Pocard
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Valleur
D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy; D003952:Diagnostic Imaging; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000453:epidemiology*; D057216:Propensity Score; D012307:Risk Factors; D016896:Treatment Outcome