Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Timing of Esophagectomy after Neoadjuvant Chemoradiation Therapy Affects the Incidence of Anastomotic Leaks

  • Roh, Simon (Division of Interventional Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center) ;
  • Iannettoni, Mark D. (Department of Cardiovasular Sciences, East Carolina University) ;
  • Keech, John (Department of Surgery, University of Iowa Hospitals and Clinics) ;
  • Arshava, Evgeny V. (Department of Surgery, University of Iowa Hospitals and Clinics) ;
  • Swatek, Anthony (Department of Surgery, University of Iowa Hospitals and Clinics) ;
  • Zimmerman, Miriam B. (Department of Biostatistics, University of Iowa College of Public Health) ;
  • Weigel, Ronald J. (Department of Surgery, University of Iowa Hospitals and Clinics) ;
  • Parekh, Kalpaj R. (Department of Surgery, University of Iowa Hospitals and Clinics)
  • Received : 2018.05.24
  • Accepted : 2018.11.14
  • Published : 2019.02.05
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Abstract

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 (${\leq}35d$), 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 ${\leq}35d$ 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 ${\leq}35d$ cohorts (p=0.044), and between the ${\leq}35d$ 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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References

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