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Morbidity and mortality after surgery for cancer of the oesophagus and gastro-oesophageal junction: A randomized clinical trial of neoadjuvant chemotherapy vs. neoadjuvant chemoradiation
Karolinska Inst, Div Surg, Dept Clin Sci Intervent & Technol, Stockholm, Sweden.;Karolinska Univ Hosp, Ctr Digest Dis, S-14186 Stockholm, Sweden..
Univ Trondheim Hosp, St Olavs Hosp, Dept Gastrointestinal Surg, Trondheim, Norway..
Ullevaal Univ Hosp, Dept Paediat & Gastrointestinal Surg, Oslo, Norway..
Haukeland Hosp, Dept Acute & Gastrointestinal Surg, N-5021 Bergen, Norway.;Univ Bergen, Dept Clin Med, N-5020 Bergen, Norway..
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2015 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 41, no 7, 920-926 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To compare the incidence and severity of postoperative complications after oesophagectomy for carcinoma of the oesophagus and gastro-oesophageal junction (GOJ) after randomized accrual to neoadjuvant chemotherapy (nCT) or neoadjuvant chemoradiotherapy (nCRT). Background: Neoadjuvant therapy improves long-term survival after oesophagectomy. To date, evidence is insufficient to determine whether combined nCT, or nCRT alone, is the most beneficial. Methods: Patients with carcinoma of the oesophagus or GOJ, resectable with a curative intention, were enrolled in this multicenter trial conducted at seven centres in Sweden and Norway. Study participants were randomized to nCT or nCRT followed by surgery with two-field lymphadenectomy. Three cycles of cisplatin/5-fluorouracil was administered in all patients, while 40 Gy of concomitant radiotherapy was administered in the nCRT group. Results: Of the randomized 181 patients, 91 were assigned to nCT and 90 to nCRT. One-hundred-and-fifty-five patients, 78 nCT and 77 nCRT, underwent resection. There was no statistically significant difference between the groups in the incidence of surgical or nonsurgical complications (P-value = 0.69 and 0.13, respectively). There was no 30-day mortality, while the 90-day mortality was 3% (2/78) in the nCT group and 6% (5/77) in the nCRT group (P = 0.24). The median Clavien-Dindo complication severity grade was significantly higher in the nCRT. group (P = 0.001). Conclusion: There was no significant difference in the incidence of complications between patients randomized to nCT and nCRT. However, complications were significantly more severe after nCRT. Registration trial database: The trial was registered in the Clinical Trials Database (registration number NCT01362127).

Place, publisher, year, edition, pages
2015. Vol. 41, no 7, 920-926 p.
Keyword [en]
Oesophageal cancer, Neoadjuvant treatment, Oesophagectomy complications
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-56397DOI: 10.1016/j.ejso.2015.03.226ISI: 000357228000017PubMedID: 25908010OAI: oai:DiVA.org:oru-56397DiVA: diva2:1082095
Available from: 2017-03-15 Created: 2017-03-15 Last updated: 2017-03-15Bibliographically approved

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