title: Clinical impact of the interval between chemoradiotherapy and esophagectomy in esophageal squamous cell carcinoma patients.
abstract: BACKGROUND
  The optimal interval between chemoradiotherapy (CRT) and esophagectomy in patients with esophageal squamous cell carcinoma is still undetermined. The aim of this study was to evaluate the association between different treatment intervals and clinical impact, including perioperative outcome and long-term survival.
  
  
  METHODS
  We retrospectively reviewed data from 665 patients with esophageal squamous cell carcinoma who underwent CRT and esophagectomy between 2008 and 2011 in Taiwan. Based on the interval between CRT and esophagectomy, patients were divided into group 1, less than 30 days; group 2, 30 to 59 days; group 3, 60 to 89 days; or group 4, 90 days or more. The impact of the treatment interval on perioperative outcomes and overall survival were assessed. A Cox regression model was used to identify prognostic factors for overall survival.
  
  
  RESULTS
  There were 90 patients in group 1, 385 patients in group 2, 141 patients in group 3, and 49 patients in group 4. The 30-day surgical mortality rate was 5.6%, 2.9%, 1.4%, and 10.2% for groups 1, 2, 3, and 4, respectively (p = 0.018). The 90-day surgical mortality rate was 12.2%, 6.8%, 5.7%, and 18.4% for groups 1, 2, 3, and 4, respectively (p = 0.012). The differences between surgical margin positivity rates were also significant: 2.2% in group 1, 4.9% in group 2, 9.2% in group 3, and 12.2% in group 4 (p = 0.032). The treatment interval was not associated with the complete response and the overall survival.
  
  
  CONCLUSIONS
  Although early operation (less than 30 days) is associated with reduced rates of surgical margin positivity, the potential benefits appear to be outweighed by the significant increase in postoperative mortality. The surgical timing that optimizes both mortality and surgical margin positivity requires further study.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital and Institute of Medicine, Chung Shan Medical University, Chung, Taichung, Taiwan; Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Bing-Yen
authors.initials: BY
authors.lastname: Wang
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hui-Shan
authors.initials: HS
authors.lastname: Chen
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan.
authors.forename: Po-Kuei
authors.initials: PK
authors.lastname: Hsu
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Chih-Shiun
authors.initials: CS
authors.lastname: Shih
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Thoracic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Chao-Yu
authors.initials: CY
authors.lastname: Liu
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Chia-Chuan
authors.initials: CC
authors.lastname: Liu
authors.affiliation: Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan. Electronic address: 156283@cch.org.tw.
authors.forename: Shiao-Chi
authors.initials: SC
authors.lastname: Wu
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome