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. 2019 Jan 29;10(5):1097-1102.
doi: 10.7150/jca.29353. eCollection 2019.

Neoadjuvant chemotherapy followed by minimally invasive esophagectomy versus primary surgery for management of esophageal carcinoma: a retrospective study

Yan Zheng  1 , Yin Li  1 , Xianben Liu  1 , Ruixiang Zhang  1 , Zongfei Wang  1 , Haibo Sun  1 , Shilei Liu  1
Affiliations

Neoadjuvant chemotherapy followed by minimally invasive esophagectomy versus primary surgery for management of esophageal carcinoma: a retrospective study

Yan Zheng et al. J Cancer. .

Abstract

There is no consensus about the combined therapeutic strategy for esophageal squamous cell carcinoma in China. The quality control and standardization of surgery procedures were far from satisfactory in past neoadjuvant chemotherapy trials, which may underestimate the survival benefits. Therefore, we tried to evaluate the survival benefit of paclitaxel plus platinum followed by minimally invasive esophagectomy with total two-field lymphadenectomy patterns versus primary surgery. Between 06/2011 and 12/2014, there were 279 consecutive patients who underwent minimally invasive esophagectomy with total two-field lymphadenectomy; 83 received neoadjuvant chemotherapy and 196 primary surgery. Propensity score matching was used to compare neoadjuvant chemotherapy patients and 76 matched primary surgery patients. Effectiveness of neoadjuvant chemotherapy, adverse events, complications after the operation, and survival rates were evaluated. After propensity score matching, and compared with primary surgery, neoadjuvant chemotherapy was significantly associated with a better survival (P = 0.049). The overall clinical response rate of neoadjuvant chemotherapy was 77.1%. The pathological response rate was 20.5%. There was no significant difference in complication rates between two groups. Neoadjuvant chemotherapy with paclitaxel plus platinum followed by minimally invasive esophagectomy and total two-field lymphadenectomy have better OS over the primary surgery without serious adverse events.

Keywords: minimally invasive esophagectomy; neoadjuvant chemotherapy; survival.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
The graph of standard lymph node dissection. (A) and (B) exposure of the left recurrent laryngeal nerve (RLN). The lymph nodes from thyroid gland and the LNs along the left RLN were removed using endoscopic scissors; (C) The region of lymph nodes dissection along the right recurrent laryngeal nerve (RLN); (D) The region of lymph nodes dissection in abdominal cavity.
Figure 2
Figure 2
Kaplan-Meier survival analysis of ESCC patients (n = 159). The survival rate of patients in the NAC group was higher than patients in the surgery alone group (log-rank test, P = 0.049).
Figure 3
Figure 3
Between 06/2011 and 12/2014, there were 279 consecutive patients who meet the criterion; 83 received NAC and 196 primary surgery. After PS matched analysis, there were 76 matched primary surgery patients. Finally, there were 159 patients included in this study. ESCC, esophageal squamous cell carcinoma; NAC, neoadjuvant chemotherapy; PS, propensity score.
See this image and copyright information in PMC

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