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KMID : 1164620190520010001
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Korean Journal of Thoracic and Cardiovascular Surgery
2019 Volume.52 No. 1 p.1 ~ p.8
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Timing of Esophagectomy after Neoadjuvant Chemoradiation Therapy Affects the Incidence of Anastomotic Leaks
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Roh Simon
Iannettoni Mark D.
Keech John
Arshava Evgeny V.
Swatek Anthony
Zimmerman Miriam B.
Weigel Ronald J.
Parekh Kalpaj R.
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Abstract
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Background: Neoadjuvant chemoradiation therapy (nCRT) has become the standard of care for esophageal cancer patients prior to esophagectomy. However, the optimal timing for surgery after completion of nCRT remains unclear.
Methods: A retrospective review was performed of patients who underwent esophagectomy with cervical anastomosis for esophageal cancer at a single institution between January 2000 and June 2015. Patients were categorized into 3 cohorts: those who did not receive nCRT prior to esophagectomy (no nCRT), those who underwent esophagectomy within 35 days after nCRT (≤35d), and those who underwent esophagectomy more than 35 days after nCRT (＞35d).
Results: A total of 366 esophagectomies were performed during the study period, and 348 patients met the inclusion criteria. Anastomotic leaks occurred in 11.8% of all patients included in the study (41 of 348). Within each cohort, anastomotic leaks were detected in 14.7% of patients (17 of 116) in the no nCRT cohort, 7.3% (13 of 177) in the ≤35d cohort, and 20.0% (11 of 55) in the ＞35d cohort (p=0.020). Significant differences in the occurrence of anastomotic leaks were observed between the no nCRT and ≤35d cohorts (p=0.044), and between the ≤35d and ＞35d cohorts (p=0.007).
Conclusion: Esophagectomy with cervical anastomosis within 35 days of nCRT resulted in a lower percentage of anastomotic leaks.
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KEYWORD
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Esophageal neoplasms, Esophagectomy, Anastomotic leak, Chemoradiotherapy, Neoadjuvant therapy
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