Impact of neoadjuvant chemoradiotherapy on postoperative outcomes after esophageal cancer resection: results of a European multicenter study.
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Gronnier Caroline, Tréchot Boris, Duhamel Alain, Mabrut Jean-Yves, Bail Jean-Pierre, Carrere Nicolas, Lefevre Jérémie H, Brigand Cécile, Vaillant Jean-Christophe, Adham Mustapha, Msika Simon, Demartines Nicolas, El Nakadi Issam, Piessen Guillaume, Meunier Bernard, Collet Denis, Mariette Christophe, FREGAT Working Group-FRENCH-AFC, Luc Guillaume, Cabau Magalie, Jougon Jacques, Badic Bogdan, Lozach Patrick, Cappeliez Serge, Lebreton Gil, Alves Arnaud, Flamein Renaud, Pezet Denis, Pipitone Federica, Iuga Bogdan Stan, Contival Nicolas, Pappalardo Eric, Mantziari Styliani, Hec Flora, Vanderbeken Marguerite, Tessier Williams, Briez Nicolas, Fredon Fabien, Gainant Alain, Mathonnet Muriel, Bigourdan Jean-Marc, Mezoughi Salim, Ducerf Christian, Baulieux Jacques, Pasquer Arnaud, Baraket Oussama, Poncet Gilles, Vaudoyer Delphine, Enfer Jourdan, Villeneuve Laurent, Glehen Olivier, Coste Thibault, Fabre Jean Michel, Marchal Frédéric, Frisoni Romain, Ayav Ahmet, Brunaud Laurent, Bresler Laurent, Cohen Charlotte, Aze Olivier, Venissac Nicolas, Pop Daniel, Mouroux Jérôme, Donici Ion, Prudhomme Michel, Felli Emanuele, Lisunfui Stéphanie, Seman Marie, Petit Gaelle Godiris, Karoui Mehdi, Tresallet Christophe, Ménégaux Fabrice, Hannoun Laurent, Malgras Brice, Lantuas Denis, Pautrat Karine, Pocard Marc, Valleur Patrice
Аннотация
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).