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Cohort Study

Patients unfit for neoadjuvant therapy may still undergo resection of locally advanced esophageal or esophagogastric junctional cancer with acceptable oncological results

Authors:

J. Robert O’Neill ,

Department of General Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, GB
About J. Robert

PhD, MRCSEd

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Ewan D. Kennedy,

Department of General Surgery, Royal Infirmary of Edinburgh, Western General Hospital, Edinburgh, GB
About Ewan D.

MBChB (Hons)

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Vicki Save,

Department of Pathology, Royal Infirmary of Edinburgh, Western General Hospital, Edinburgh, GB
About Vicki

FRCPath

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Barbara Langdale-Brown,

Department of Pathology, Royal Infirmary of Edinburgh, Western General Hospital, Edinburgh, GB
About Barbara

FRCPath

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Lucy Wall,

Department of Oncology, Western General Hospital, Edinburgh, GB
About Lucy

MD, FRCP

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Richard J.E. Skipworth,

Department of General Surgery, Royal Infirmary of Edinburgh, Western General Hospital, Edinburgh, GB
About Richard J.E.

MD, FRCSEd

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Simon Paterson-Brown

Department of General Surgery, Royal Infirmary of Edinburgh, Western General Hospital, Edinburgh, GB
About Simon

MS, FRCSEd

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Abstract

Introduction: Neoadjuvant chemotherapy (NA) is routinely offered to patients undergoing resection for locally advanced (≥ cT3Nx or cTxN +) esophageal or esophagogastric junctional (EGJ) cancer in the United Kingdom. Patients with comorbidity precluding the use of NA can be considered for resection yet the effect of omitting NA on survival is unclear.

Methods: Retrospective review of prospectively collected clinical data from patients undergoing attempted curative therapy for ≥ cT3Nx or cTxN+ esophageal or EGJ (Siewert type I-III) cancer between 2001 and 2013.

Results: NA was commenced in 289 patients and primarily comprised 2 cycles of cisplatin and 5-fluorouracil (264 patients, 91%). Surgery alone was planned for 82 patients with NA omitted due to comorbidity. Patients undergoing surgery alone were matched for clinical variables and stage with those undergoing NA but were significantly older (mean =8 y, P <0.001). NA was associated with an improved median overall survival of 28.7 months, compared with 20.9 months for patients undergoing surgery alone (P= 0.008).

Patients undergoing surgery alone had a 90-day postoperative mortality rate of 10% compared with 3% for those undergoing NA (P =0.011). In patients discharged postoperatively, the median overall survival benefit of NA was 2.7 months (P=0.048). Those 19% of patients experiencing a significant histologic response to NA demonstrated further improved survival.

Conclusions: NA improves survival in patients undergoing resection for locally advanced esophageal or EGJ cancer; however, the median benefit is <3 months in patients discharged postoperatively. Patients precluded from NA achieve acceptable oncological results but experience a higher risk of perioperative mortality.

How to Cite: O’Neill JR, Kennedy ED, Save V, Langdale-Brown B, Wall L, Skipworth RJE, et al.. Patients unfit for neoadjuvant therapy may still undergo resection of locally advanced esophageal or esophagogastric junctional cancer with acceptable oncological results. International Journal of Surgery: Oncology. 2017;2(2):e09. DOI: http://doi.org/10.1097/IJ9.0000000000000009
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Published on 03 Feb 2017.
Peer Reviewed

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