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. 2022 May;148(5):1223-1234.
doi: 10.1007/s00432-021-03720-5. Epub 2021 Jul 5.

Short-term outcome of Ivor Lewis esophagectomy following neoadjuvant chemoradiation versus perioperative chemotherapy in patients with locally advanced adenocarcinoma of the esophagus and gastroesophageal junction: a propensity score-matched analysis

Patrick Sven Plum #  1   2 , Alexander Damanakis #  3 , Lisa Buschmann  4 , Angela Ernst  5 , Rabi Raj Datta  3 , Lars Mortimer Schiffmann  3 , Thomas Zander  6 , Hans Fuchs  3 , Seung-Hun Chon  3 , Hakan Alakus  3 , Wolfgang Schröder  3 , Arnulf Heinrich Hölscher  7 , Christiane Josephine Bruns  3 , Marc Bludau  3
Affiliations

Short-term outcome of Ivor Lewis esophagectomy following neoadjuvant chemoradiation versus perioperative chemotherapy in patients with locally advanced adenocarcinoma of the esophagus and gastroesophageal junction: a propensity score-matched analysis

Patrick Sven Plum et al. J Cancer Res Clin Oncol. 2022 May.

Abstract

Background: Patients with locally advanced esophageal or gastroesophageal adenocarcinoma benefit from multimodal therapy concepts including neoadjuvant chemoradiation (nCRT), respectively, perioperative chemotherapy (pCT). However, it remains unclear which treatment is superior concerning postoperative morbidity.

Methods: In this study, we compared the postsurgical survival (30-day/90-day/1-year mortality) (primary endpoint), treatment response, and surgical complications (secondary endpoints) of patients who either received nCRT (CROSS protocol) or pCT (FLOT protocol) due to esophageal/gastroesophageal adenocarcinoma. Between January 2013 and December 2017, 873 patients underwent Ivor Lewis esophagectomy in our high-volume center. 339 patients received nCRT and 97 underwent pCT. After 1:1 propensity score matching (matching criteria: sex, age, BMI, ASA score, and Charlson score), 97 patients per subgroup were included for analysis.

Results: After matching, tumor response (ypT/ypN) did not differ significantly between nCRT and pCT (p = 0.118, respectively, p = 0.174). Residual nodal metastasis occurred more often after pCT (p = 0.001). Postsurgical mortality was comparable within both groups. No patient died within 30 or 90 days after surgery while the 1-year survival rate was 72.2% for nCRT and 68.0% for pCT (p = 0.47). Only grade 3a complications according to Clavien-Dindo were increased after pCT (p = 0.04). There was a trend towards a higher rate of pylorospasm within the pCT group (nCRT: 23.7% versus pCT: 37.1%) (p = 0.061). Multivariate analysis identified pCT, younger age, and Charlson score as independent variables for pylorospasm.

Conclusion: Both nCRT and pCT are safe and efficient within the multimodal treatment of esophageal/gastroesophageal adenocarcinoma. We did not observe differences in postoperative morbidity. However, functional aspects such as gastric emptying might be more frequent after pCT.

Keywords: Chemoradiation; Chemotherapy; Esophageal/gastroesophageal adenocarcinoma; Ivor Lewis esophagectomy; Neoadjuvant treatment; Outcome; Prognosis.

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Conflict of interest statement

Patrick Sven Plum is a fellow of the Else Kröner Forschungskolleg Cologne “Clonal Evolution in Cancer” (2016-Kolleg-19). All other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow-chart of patient selection and matching
Fig. 2
Fig. 2
Kaplan–Meier survival analysis (log-rank test) of the 1-year survival for patients with neoadjuvant chemoradiation (nCRT) versus perioperative chemotherapy (pCT)
See this image and copyright information in PMC

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Supplementary concepts