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Surgical Morbidity and Mortality From the Multicenter Randomized Controlled NeoRes II Trial: Standard Versus Prolonged Time to Surgery After Neoadjuvant Chemoradiotherapy for Esophageal Cancer.
Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institute, Stockholm, Sweden.
Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institute, Stockholm, Sweden.
Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institute, Stockholm, Sweden.
Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institute, Stockholm, Sweden.
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2020 (English)In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 272, no 5, p. 684-689Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate if prolonged TTS after completed nCRT improves postoperative outcomes for esophageal and esophagogastric junction cancer.

SUMMARY OF BACKGROUND DATA: TTS has traditionally been 4-6 weeks after completed nCRT. However, the optimal timing is not known.

METHODS: A multicenter clinical trial was performed with randomized allocation of TTS of 4-6 or 10-12 weeks. The primary endpoint of this sub-study was overall postoperative complications defined as Clavien-Dindo grade II-V. Secondary endpoints included complication severity according to Clavien-Dindo grade IIIb-V, postoperative 90-day mortality, and length of hospital stay. The study was registered in Clinicaltrials.gov (NCT02415101).

RESULTS: In total 249 patients were randomized. There were no significant differences between standard TTS and prolonged TTS with regard to overall incidence of complications Clavien-Dindo grade II-V (63.2% vs 72.6%, P = 0.134) or regarding Clavien-Dindo grade IIIb-V complications (31.6% vs 34.9%, P = 0.603). There were no statistically significant differences between standard and prolonged TTS regarding anastomotic leak (P = 0.596), conduit necrosis (P = 0.524), chyle leak (P = 0.427), pneumonia (P = 0.548), and respiratory failure (P = 0.723). In the standard TTS arm 5 patients (4.3%) died within 90 days of surgery, compared to 4 patients (3.8%) in the prolonged TTS arm (P = 1.0). Median length of hospital stay was 15 days in the standard TTS arm and 17 days in the prolonged TTS arm (P = 0.234).

CONCLUSION: The timing of surgery after completed nCRT for carcinoma of the esophagus or esophagogastric junction, is not of major importance with regard to short-term postoperative outcomes.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2020. Vol. 272, no 5, p. 684-689
Keywords [en]
esophageal cancer, esophageal carcinoma, esophagectomy, esophagogastric cancer, neoadjuvant chemoradiotherapy, neoadjuvant treatment, postoperative morbidity, postoperative mortality, surgical resection, time to surgery, timing of surgery
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-85124DOI: 10.1097/SLA.0000000000004340ISI: 000619410000003PubMedID: 32833767Scopus ID: 2-s2.0-85092943866OAI: oai:DiVA.org:oru-85124DiVA, id: diva2:1464602
Funder
Swedish Cancer Society
Note

Funding Agencies:

Region of Stockholm (ALF)  

Stockholm Cancer Society (Radiumhemmets forskningsfonder)  

Available from: 2020-09-07 Created: 2020-09-07 Last updated: 2021-03-09Bibliographically approved

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Szabo, Eva

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