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 to 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...
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| Veröffentlicht in: | European journal of surgical oncology 2016-08, Vol.42 (8), p.1183-1190 |
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| creator | Kathiravetpillai, N., MD Koëter, M., MD van der Sangen, M.J.C., MD, PhD Creemers, G.J., MD, PhD Luyer, M.D.P., MD, PhD Rutten, H.J.T., MD, PhD Nieuwenhuijzen, G.A.P., MD, PhD |
| description | Abstract Background Patients with resectable oesophageal cancer are treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery within 3 to 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. |
| doi_str_mv | 10.1016/j.ejso.2016.03.033 |
| format | Article |
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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.</description><identifier>ISSN: 0748-7983</identifier><identifier>EISSN: 1532-2157</identifier><identifier>DOI: 10.1016/j.ejso.2016.03.033</identifier><identifier>PMID: 27134188</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adenocarcinoma - pathology ; Adenocarcinoma - therapy ; Aged ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Carboplatin - administration & dosage ; Chemoradiotherapy ; Esophageal Neoplasms - pathology ; Esophageal Neoplasms - therapy ; Esophagectomy - methods ; Female ; Fluorouracil - administration & dosage ; Hematology, Oncology and Palliative Medicine ; Humans ; Interval ; Male ; Middle Aged ; Neoadjuvant chemoradiotherapy ; Neoadjuvant Therapy ; Neoplasm Staging ; Oesophageal adenocarcinoma ; Paclitaxel - administration & dosage ; Postoperative Complications - epidemiology ; Postoperative outcome ; Radiotherapy, Conformal ; Retrospective Studies ; Surgery ; Time Factors ; Treatment Outcome</subject><ispartof>European journal of surgical oncology, 2016-08, Vol.42 (8), p.1183-1190</ispartof><rights>2016 Elsevier Ltd</rights><rights>Copyright © 2016 Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-3ace4e89e9078e149558bfe2ff96ba5a727861064156dab28a6796a0536a9c7f3</citedby><cites>FETCH-LOGICAL-c411t-3ace4e89e9078e149558bfe2ff96ba5a727861064156dab28a6796a0536a9c7f3</cites><orcidid>0000-0002-9483-1520 ; 0000-0003-4759-5761 ; 0000-0003-2849-3786</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0748798316300518$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27134188$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kathiravetpillai, N., MD</creatorcontrib><creatorcontrib>Koëter, M., MD</creatorcontrib><creatorcontrib>van der Sangen, M.J.C., MD, PhD</creatorcontrib><creatorcontrib>Creemers, G.J., MD, PhD</creatorcontrib><creatorcontrib>Luyer, M.D.P., MD, PhD</creatorcontrib><creatorcontrib>Rutten, H.J.T., MD, PhD</creatorcontrib><creatorcontrib>Nieuwenhuijzen, G.A.P., MD, PhD</creatorcontrib><title>Delaying surgery after neoadjuvant chemoradiotherapy does not significantly influence postoperative morbidity or oncological outcome in patients with oesophageal adenocarcinoma</title><title>European journal of surgical oncology</title><addtitle>Eur J Surg Oncol</addtitle><description>Abstract Background Patients with resectable oesophageal cancer are treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery within 3 to 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.</description><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - therapy</subject><subject>Aged</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Carboplatin - administration & dosage</subject><subject>Chemoradiotherapy</subject><subject>Esophageal Neoplasms - pathology</subject><subject>Esophageal Neoplasms - therapy</subject><subject>Esophagectomy - methods</subject><subject>Female</subject><subject>Fluorouracil - administration & dosage</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Interval</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoadjuvant chemoradiotherapy</subject><subject>Neoadjuvant Therapy</subject><subject>Neoplasm Staging</subject><subject>Oesophageal adenocarcinoma</subject><subject>Paclitaxel - administration & dosage</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative outcome</subject><subject>Radiotherapy, Conformal</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0748-7983</issn><issn>1532-2157</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kkur1TAUhYMo3uPVP-BAMnTSYx59gghyfcIFB-o4pOluT2qbXZP0XPqv_ImmnKsDB8KGZPCtBXutTchzzo6c8fLVeIQx4FGk_5HJNPIBOfBCikzwonpIDqzK66xqanlFnoQwMsYaWTWPyZWouMx5XR_Ir3cw6c26gYbVD-A3qvsInjpA3Y3rWbtIzQlm9LqzGE_g9bLRDiFQh5EGOzjbW5OwaaPW9dMKzgBdMERcEhztGWhSt7azcaPoKTqDEw5JM1Fco8EZkpAuCQUXA72z8USTPy4nPUCCdAcOjfbGOpz1U_Ko11OAZ_fvNfn-4f23m0_Z7ZePn2_e3mYm5zxmUhvIoW6gYVUNPG-Kom57EH3flK0udCWquuSszHlRdroVtS6rptSskKVuTNXLa_Ly4rt4_LlCiGq2wcA06RTNGhSvkzhlKEVCxQU1HkPw0KvF21n7TXGm9qbUqPam1N6UYjKNTKIX9_5rO0P3V_KnmgS8vgCQtjxb8CoYu4fbWQ8mqg7t__3f_CM3k3V76j9ggzDi6l3KT3EVhGLq634r-6nwUjJWpL1-A4TXwB0</recordid><startdate>20160801</startdate><enddate>20160801</enddate><creator>Kathiravetpillai, N., MD</creator><creator>Koëter, M., MD</creator><creator>van der Sangen, M.J.C., MD, PhD</creator><creator>Creemers, G.J., MD, PhD</creator><creator>Luyer, M.D.P., MD, PhD</creator><creator>Rutten, H.J.T., MD, PhD</creator><creator>Nieuwenhuijzen, G.A.P., MD, PhD</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9483-1520</orcidid><orcidid>https://orcid.org/0000-0003-4759-5761</orcidid><orcidid>https://orcid.org/0000-0003-2849-3786</orcidid></search><sort><creationdate>20160801</creationdate><title>Delaying surgery after neoadjuvant chemoradiotherapy does not significantly influence postoperative morbidity or oncological outcome in patients with oesophageal adenocarcinoma</title><author>Kathiravetpillai, N., MD ; Koëter, M., MD ; van der Sangen, M.J.C., MD, PhD ; Creemers, G.J., MD, PhD ; Luyer, M.D.P., MD, PhD ; Rutten, H.J.T., MD, PhD ; Nieuwenhuijzen, G.A.P., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-3ace4e89e9078e149558bfe2ff96ba5a727861064156dab28a6796a0536a9c7f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - therapy</topic><topic>Aged</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Carboplatin - administration & dosage</topic><topic>Chemoradiotherapy</topic><topic>Esophageal Neoplasms - pathology</topic><topic>Esophageal Neoplasms - therapy</topic><topic>Esophagectomy - methods</topic><topic>Female</topic><topic>Fluorouracil - administration & dosage</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Interval</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoadjuvant chemoradiotherapy</topic><topic>Neoadjuvant Therapy</topic><topic>Neoplasm Staging</topic><topic>Oesophageal adenocarcinoma</topic><topic>Paclitaxel - administration & dosage</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative outcome</topic><topic>Radiotherapy, Conformal</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kathiravetpillai, N., MD</creatorcontrib><creatorcontrib>Koëter, M., MD</creatorcontrib><creatorcontrib>van der Sangen, M.J.C., MD, PhD</creatorcontrib><creatorcontrib>Creemers, G.J., MD, PhD</creatorcontrib><creatorcontrib>Luyer, M.D.P., MD, PhD</creatorcontrib><creatorcontrib>Rutten, H.J.T., MD, PhD</creatorcontrib><creatorcontrib>Nieuwenhuijzen, G.A.P., MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kathiravetpillai, N., MD</au><au>Koëter, M., MD</au><au>van der Sangen, M.J.C., MD, PhD</au><au>Creemers, G.J., MD, PhD</au><au>Luyer, M.D.P., MD, PhD</au><au>Rutten, H.J.T., MD, PhD</au><au>Nieuwenhuijzen, G.A.P., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Delaying surgery after neoadjuvant chemoradiotherapy does not significantly influence postoperative morbidity or oncological outcome in patients with oesophageal adenocarcinoma</atitle><jtitle>European journal of surgical oncology</jtitle><addtitle>Eur J Surg Oncol</addtitle><date>2016-08-01</date><risdate>2016</risdate><volume>42</volume><issue>8</issue><spage>1183</spage><epage>1190</epage><pages>1183-1190</pages><issn>0748-7983</issn><eissn>1532-2157</eissn><abstract>Abstract Background Patients with resectable oesophageal cancer are treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery within 3 to 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.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>27134188</pmid><doi>10.1016/j.ejso.2016.03.033</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-9483-1520</orcidid><orcidid>https://orcid.org/0000-0003-4759-5761</orcidid><orcidid>https://orcid.org/0000-0003-2849-3786</orcidid></addata></record> |
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| subjects | Adenocarcinoma - pathology Adenocarcinoma - therapy Aged Antineoplastic Combined Chemotherapy Protocols - therapeutic use Carboplatin - administration & dosage Chemoradiotherapy Esophageal Neoplasms - pathology Esophageal Neoplasms - therapy Esophagectomy - methods Female Fluorouracil - administration & dosage Hematology, Oncology and Palliative Medicine Humans Interval Male Middle Aged Neoadjuvant chemoradiotherapy Neoadjuvant Therapy Neoplasm Staging Oesophageal adenocarcinoma Paclitaxel - administration & dosage Postoperative Complications - epidemiology Postoperative outcome Radiotherapy, Conformal Retrospective Studies Surgery Time Factors Treatment Outcome |
| title | Delaying surgery after neoadjuvant chemoradiotherapy does not significantly influence postoperative morbidity or oncological outcome in patients with oesophageal adenocarcinoma |
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