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Impact of Neoadjuvant Chemoradiotherapy on Postoperative Outcomes After Esophageal Cancer Resection

Caroline Gronnier 1, 2, 3 Boris Tréchot 2 Alain Duhamel 4, 5 Jean-Yves Mabrut 6 Jean-Pierre Bail 7 Nicolas Carrère 8 Jérémie Lefevre 9 Cécile Brigand 10 Christophe Vaillant 11 Mustapha Adham 12 Simon Msika 13 Nicolas Demartines 14 Issam El Nakadi 15 Guillaume Piessen 1, 2, 3 Bernard Meunier 16 Denis Collet 17 Christophe Mariette 1, 2, 3, 4 G. Luc Magalie Cabau 18 Jacques Jougon 19 Bogdan Badic 20 Patrick Lozach Serge Cappeliez G. Lebreton A. Alves Renaud Flamein 21 Denis Pezet 22 Federica Pipitone Nicolas Contival Eric Pappalardo Styliani Mantziari F. Hec Marguerite Vanderbeken Williams Tessier Nicolas Briez 23 F Fredon Alain Gainant 24 Muriel Mathonnet 25 Jm Bigourdan Salim Mezoughi C. Ducerf 26 Jacques Baulieux Arnaud Pasquer 12 Oussama Baraket Gilles Poncet 27 Delphine Vaudoyer J Enfer L Villeneuve O. Glehen 28 T Coste J.M Fabre 29 F Marchal Romain Frisoni Ahmet Ayav 30 Laurent Brunaud 30, 31 Laurent Bresler 30 C Cohen Olivier Aze Nicolas Vénissac 32 D. Pop J Mouroux Ion Donici M. Prudhomme E. Felli Stéphanie Lisunfui Marie Seman Gaelle Godiris Petit M Karoui Christophe Tresallet 33
Abstract : Objectives: 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).
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Submitted on : Monday, January 22, 2018 - 12:05:21 PM
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Caroline Gronnier, Boris Tréchot, Alain Duhamel, Jean-Yves Mabrut, Jean-Pierre Bail, et al.. Impact of Neoadjuvant Chemoradiotherapy on Postoperative Outcomes After Esophageal Cancer Resection. Annals of Surgery, Lippincott, Williams & Wilkins, 2014, 260 (5), pp.764 - 771. ⟨10.1097/SLA.0000000000000955⟩. ⟨hal-01689618⟩

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