title: Delaying surgery after neoadjuvant chemoradiotherapy does not significantly influence postoperative morbidity or oncological outcome in patients with oesophageal adenocarcinoma.
abstract: BACKGROUND
  Patients with resectable oesophageal cancer are treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery within 3-8 weeks. In practice, surgery is often delayed for various reasons. The aim of this study was to evaluate whether delaying surgery beyond 8 weeks has an effect on postoperative morbidity, long-term survival, and pathologic response in patients treated for oesophageal ADC.
  
  
  METHODS
  Patients who underwent nCRT followed by surgery, for cT1-3, N0-3, M0 ADC between 2001 and 2014 were retrospectively included from a prospectively obtained database. Patients with a time from the end of nCRT to surgery (TTS) ≤8 weeks were compared with patients with a TTS >8 weeks.
  
  
  RESULTS
  Of 190 patients, 65 had a TTS ≤8 weeks, and 125 had a TTS >8 weeks. Patient characteristics were comparable for both groups, but patients with TTS >8 weeks exhibited higher ASA scores (p = 0.013) and more comorbidities (p = 0.007). Multivariate analysis revealed that TTS did not significantly influence postoperative morbidity, pathologic complete response rates, and five-year survival rates (42% in patients with TTS ≤8 weeks and 37% in patients with TTS >8 weeks).
  
  
  CONCLUSIONS
  Delaying surgery beyond 8 weeks after nCRT did not significantly influence postoperative morbidity, pathologic response, and survival in patients with non-metastatic ADC. Therefore, it appears reasonable to postpone surgery beyond 8 weeks in patients who have not yet recovered from nCRT. However, if the patient is fit for surgery, postponing surgery does not have any additional advantages.
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Kathiravetpillai
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Koëter
authors.affiliation: Department of Radiation Oncology, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: M J C
authors.initials: MJ
authors.lastname: van der Sangen
authors.affiliation: Department of Oncology, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: G J
authors.initials: GJ
authors.lastname: Creemers
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: M D P
authors.initials: MD
authors.lastname: Luyer
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands.
authors.forename: H J T
authors.initials: HJ
authors.lastname: Rutten
authors.affiliation: Department of Surgery, Catharina Hospital Eindhoven, The Netherlands. Electronic address: grard.nieuwenhuijzen@catharinaziekenhuis.nl.
authors.forename: G A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D011183:Postoperative Complications / Q000453:epidemiology*; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D016190:Carboplatin; D017239:Paclitaxel; D005472:Fluorouracil
keywords: Interval; Neoadjuvant chemoradiotherapy; Oesophageal adenocarcinoma; Postoperative outcome