The Effect of Neoadjuvant Therapy on Early Complications of Esophageal Cancer Surgery

Document Type : Original

Authors

1 Endoscopic & Minimally Invasive Surgery Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Cardio-Thoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Department of Radiotherapy & oncology, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

6 Sinus and Surgical Endoscopic Research Center, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction:
Early diagnosis and appropriate treatment is required in esophageal cancer due to its invasive nature. The aim of this study was to evaluate early post-esophagectomy complications in patients with esophageal cancer who received neoadjuvant chemoradiotherapy (NACR).
 
Materials and Methods:
This randomized clinical trial was carried out between 2009 and 2011. Patients with lower-third esophageal cancer were randomly assigned to one of two groups. The first group consisted of 50 patients receiving standard chemoradiotherapy (Group A) and then undergoing surgery, and the second group consisted of 50 patients undergoing surgery only (Group B). Patients were evaluated with respect to age, gender, clinical symptoms, type of pathology, time of surgery, perioperative blood loss, and number of lymph nodes resected as well as early post-operative complicate including leakage at the anastomosis site, chylothorax and pulmonary complications, hospitalization period, and mortality rate within the first 30 days after surgery.
 
Results:
The mean age of patients was 55 years. Seventy-two patients had squamous cell carcinoma (SCC) and 28 patients had adenocarcinoma (ACC). There was no significant difference between the two groups with respect to age, gender, time of surgery, complications including anastomotic leakage, chylothorax, pulmonary complications, cardiac complications, deep venous thrombosis (DVT), or mortality. However, there was a significant difference between the two groups regarding hospital stay, time of surgery, perioperative blood loss, and number of lymph nodes resected.
 
Conclusion: 
The use of NACR did not increase early post-operative complications or mortality among patients with esophageal cancer. 

Keywords

Main Subjects


1. Hale DA, Molloy M, Pearl RH, Schutt DC, Jaques DP. Appendectomy: a contemporary appraisal. Ann Surg. 1997; 225(3):252–61.
2. Siegel R, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: the impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin. 2011; 61(4):          212–36.
3. Brenner B, Ilson DH, Minsky BD, Bains MS, Tong W, Gonen M, et al. Phase I trial of combined-modality therapy for localized esophageal cancer: escalating doses of continuous-infusion paclitaxel with cisplatin and concurrent radiation therapy. J Clin Oncol. 2004; 22:45–52.
4. Berger AC, Farma J, Scott WJ, Freedman G, Weiner L, Cheng JD, et al. Complete response to neoadjuvant chemora- diotherapy in esophageal carcinoma is associated with significantly improved survival. J Clin Oncol 2005;23(19):4330–7.
5. Lv J, Cao XF, Zhu B, Ji L, Tao L, Wang DD. Effect of neoadjuvant chemoradiotherapy on prognosis and surgery for esophageal carcinoma. World J Gastroenterol 2009;15(39):4962–8.
6. Bagheri R, Maddah G, Saedi HS, Sadeghian MH, Roodbari S. Bone marrow involvement in esophageal cancer patients who underwent surgical resection. Eur J Cardiothorac Surg. 2011; 40(2): 343–6.
7. Bonavia L, Soligo D, Quiricin N, Bossolasco P, Cesana B, Lembertenghi Deliliers G, et al. Bon marrow- disseminated tumor cells in patients with carcinoma of the esophagus or cardia. Surgery 2001; 129(1):15-22.
 
8. Bagheri R, RajabiMashhadi MT, Ghazvini K, Asnaashari A, Zahediyan A, Sahebi MA. The effect of neoadjuvant chemoradiotherapy on airway colonization and postoperative respiratory compli- cations in patients undergoing oesopha- gectomy for oesophageal cancer Interact Cardiovasc Thorac Surg 2012;14(6):725–8.
9. Kelsen D. Preoperative chemoradiotherapy for esophageal cancer. J Clin Oncol 2001; 19(2): 283–5.
 
10. Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma J Clin Oncol 2001;19(2):305–13.
 
11. Urschel JD, Vasan H. A meta-analysis of randomized controlled trials that compared neoadjuvant chemoradiation and surgery to surgery alone for resectable esophageal cancer. Am J Surg 2003; 185(6):538–43.
 
12. Liao Z, Zhang Z, Jin J, Ajani JA, Swisher SG, Stevens CW, et al. Esophagectomy after concurrent
 
chemoradiotherapy improves locoregional control in clinical stage II or III esophageal cancer patients. Int J Radiat Oncol Biol Phys 2004; 60(5):1484–93.
13. Lew JI, Gooding WE, Ribeiro U Jr, Safatle-Ribeiro AV, Posner MC. Long-term survival following induction chemoradiotherapy and esophagectomy for esophageal carcinoma. Arch Surg 2001;136(7):737–42.
14. Berger AC, Scott WJ, Freedman G, Konski A, Weiner L, Cheng JD, et al. Morbidity and Morality are not increased After induction Chemora- diotheraphy Followed by Esophagectomy in Patients With Esophageal Cancer. Seminars in Oncology 2005; 32(9): 16–20.
15. Jones DR, Detterbeck FC, Egan TM, Parker LA Jr, Bernard SA, Tepper JE. Induction chemora- diotherapy followed by esophagectomy in patients with carcinoma of the esophagus. Ann Thorac Surg 1997; 64(1):185–91.
16. Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, et al. Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus. N Engl J Med 1997;337:161–7.
17. Ruol A, Portale G, Castoro C, Merigliano S, Cagol M, Cavallin F. Effects of neoadjuvant therapy on perioperative morbidity in elderly patients undergoing esophagectomy for esophageal cancer Ann Surg Oncol 2007;14(11):3243–50.
18. Kawamura K, Takiguchi N, Wada A, Takenobu H, Kimura H, Soda H, et al. Up-regulated expression of the uridine phosphorylase gene in human gastric tumors is correlated with a favorable prognosis. Anticancer Res 2006; 26(6c):4647–51.
19. Van Hagen P, Hulshof M, Van Lanschot J, Steyerberg EW, Van Berge Henegouwen MI, Wijnhoven B, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012;366:2074–84.
20. Slater MS, Holland J, Faigel DO, Sheppard BC, Deveney CW. Does neoadjuvant chemoradiation downstage esophageal carcinoma? Am J Surg 2001; 181(5):440–4.
21. Doty JR, Salazar JD, Forastiere AA, Heath EI, Kleinberg L, Heitmiller RF. Postesophagectomy morbidity, mortality, and length of hospital stay after preoperative chemoradiation therapy Ann Thorac Surg 2002; 74(1):227–31.
22. Heise JW, Heep H, Frieling T, Sarbia M, Hartmann KA, Röher HD. Expense and benefit of neoadjuvant treatment in squamous cell carcinoma of the esophagus. BMC Cancer 2001;1:20.