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Randomized Controlled Trial
. 2022 Nov;407(7):2673-2680.
doi: 10.1007/s00423-022-02646-x. Epub 2022 Aug 25.

Comparison of pulmonary function changes between patients receiving neoadjuvant chemotherapy and chemoradiotherapy prior to minimally invasive esophagectomy: a randomized and controlled trial

Xiaosang Chen  1 , Mingjun Du  2 , Han Tang  1 , Hao Wang  1 , Yong Fang  1 , Miao Lin  1 , Jun Yin  1 , Lijie Tan  3 , Yaxing Shen  4   5
Affiliations
Randomized Controlled Trial

Comparison of pulmonary function changes between patients receiving neoadjuvant chemotherapy and chemoradiotherapy prior to minimally invasive esophagectomy: a randomized and controlled trial

Xiaosang Chen et al. Langenbecks Arch Surg. 2022 Nov.

Abstract

Purpose: Adequate pulmonary function is important for patients undergoing surgical resection of esophageal cancer, especially those that received neoadjuvant therapy. However, it is unknown if pre-operative radiation affects pulmonary function differently compared to chemotherapy. The purpose of this study was to compare changes in pulmonary function between patients undergoing minimally invasive esophagectomy (MIE) who received neoadjuvant chemotherapy or chemoradiotherapy.

Methods: Between March 2017 and March 2018, esophageal cancer patients requiring neoadjuvant therapy were prospectively enrolled and randomly assigned to receive chemotherapy (CT) or chemoradiotherapy (CRT) before MIE. All patients received pulmonary function testing before and after the neoadjuvant therapy. Changes in pulmonary function, operative data, and pulmonary complications were compared between the 2 groups.

Results: A total of 71 patients were randomized and underwent MIE after receiving CT (n = 34) or CRT (n = 37). Baseline clinical characteristics were comparable between the 2 groups. The CRT group experienced a greater decrease of forced expiratory volume at 1 s (FEV1) (2.66 to 2.18 L, p = 0.023) and diffusion capacity of the lung for carbon monoxide divided by the mean alveolar volume (DLCO/Va) (17.3%, p < 0.001) than the CT group (FEV1 2.53 to 2.41 L; DLCO/Va 4.8%). The incidence of pulmonary complications was higher in the CRT group (13.51 vs. 8.82%), but the difference was not significant (p = 0.532).

Conclusions: Preoperative CRT affects pulmonary function more than CT alone, but does not increase the risk of pulmonary complications in patients undergoing MIE.

Keywords: Esophageal cancer; Neo-adjuvant therapy; Pulmonary function.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of patient inclusion. CT, chemotherapy; CRT, chemoradiotherapy
Fig. 2
Fig. 2
Changes in pulmonary function before and after neoadjuvant therapy. CT: FEV1 decrease from 2.53 to 2.41 L. CRT: FEV1 decrease from 2.66 to 2.18 L. CT: Average DLCO/Va decrease 4.8%. CRT: Average DLCO/Va decrease 17.3%. The CRT group experienced a greater decrease in both FEV1 (p = 0.023) and DLCO/Va (p < 0.001) than the CT group. CT, chemotherapy; CRT, chemoradiotherapy
Fig. 3
Fig. 3
Pulmonary complications after minimally invasive esophagectomy. A total of 8 patients (11.27%) developed pulmonary complications: 5 patients (13.51%) in CRT group and 3 patients (8.82%) in CT group. The frequency of pulmonary complications between the 2 groups was not statistically different (p = 0.532). Pulmonary complications included 2 cases of ARDS, 2 cases of pneumonia, 3 cases of pleural effusion requiring chest tube insertion and drainage, and 1 case of atelectasis. All complications resolved with appropriate management
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