Outcome of neoadjuvant therapies for cancer of the oesophagus or gastro-oesophageal junction based on a national data registry

Klevebro, Fredrik; Lindblad, Mats; Johansson, Jesper; Lundell, Lars; Nilsson, Magnus

doi:10.1002/bjs.10304

Cited by 30 publications

(23 citation statements)

References 37 publications

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“…Most previous studies revealed nCRT was not associated with improved survival in spite of its apparent elevated pCR rate compared with nCT (3,20,21,25). It was worth mentioning that nCRT group carried an increased risk of postoperative mortality or had more deaths unrelated to disease progression in the first-year follow up period in these studies.…”

Section: Discussionmentioning

confidence: 69%

“…In other trials, lymph node retrieval after nCRT also appeared to be lower (1,20,27). Besides, it was reported that chemoradiotherapy reduced lymph node harvest from within the radiotherapy field in rectal cancer (28,29).Most previous studies revealed nCRT was not associated with improved survival in spite of its apparent elevated pCR rate compared with nCT (3,20,21,25). It was worth mentioning that nCRT group carried an increased risk of postoperative mortality or had more deaths unrelated to disease progression in the first-year follow up period in these studies.…”

mentioning

confidence: 78%

“…Although nCRT was the primary procedure in western world, nCT was the mainstream in eastern world due to nCRT's high risk of postoperative mortality for ESCC, which may couteract its long-term survival benefits (2,3,19,20). Studies directly comparing the outcomes of nCRT with nCT were also performed.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, ESCC was more likely to achieve an early ypTNM stage than adenocarcinoma by In the present study, fewer lymph nodes were harvested after nCRT than nCT, despite no difference in dissected regions. In other trials, lymph node retrieval after nCRT also appeared to be lower (1,20,27). Besides, it was reported that chemoradiotherapy reduced lymph node harvest from within the radiotherapy field in rectal cancer (28,29).…”

mentioning

confidence: 87%

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Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?

et al. 2018

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Background: Few studies reported the outcomes of minimally invasive esophagectomy (MIE) in treating patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (nCRT).The aim of the study was to investigate the feasibility and efficacy of nCRT plus MIE (RM) strategy in treating locally advanced resectable ESCC.Methods: This retrospective study included 175 patients with ESCC undergoing surgical resection after neoadjuvant therapy in our institution from 2010 to 2016. Patients were stratified into three groups: RM, [neoadjuvant chemotherapy (nCT) plus MIE] (CM) and [nCT plus open esophagectomy (OE)] (CO).Results: Seventy-six (43.4%), 42 (24%) and 57 (32.6%) patients received RM, CM and CO approach, There were no differences in 30-and 90-day mortality among all groups. RM approach was more likely to achieve pathological complete regression (27.6% vs. 4.8%, 1.8%, P=0.001, P=0.001) and fewer lymph node metastasis (25.0% vs. 57.1%, 61.4%, P=0.001, P=0.001) than CM or CO approach. Survival analysis revealed a potential trend towards improved overall survival in RM approach compared with CM or CO approach (P=0.098, P=0.166).Conclusions: RM approach was a safe and efficient strategy in treating locally advanced resectable ESCC. Thereafter, nCT, a safe approach (3)(4)(5)(6) showing improved survival compared with surgery alone, is being applied as the standard approach for ESCC in the east.As is known to all, minimally invasive esophagectomy (MIE) had great advantages in improving short-term outcomes without compromised long-term survival (7)(8)(9). Recently, it is also demonstrated MIE is an acceptable surgical therapy for advanced-stage esophageal malignancies after nCRT (10-13). Nevertheless, the studies available included majorities of patients with adenocarcinoma located in the distal esophagus, which might be more favourable for MIE. As for locally advanced bulky ESCC, it is dangerous to resect as is mainly located in upper or middle-third of esophagus and closely adjacent to the tracheobronchial tree. The safety of MIE after neoadjuvant therapy in treating such patients has never been evaluated in a relative large sample size. Moreover, as patients with ESCC suffered from high incidence of postoperative mortality after nCRT, it is worthwhile to investigate whether MIE could lower the risk of mortality after neoadjuvant therapy, whether nCRT plus MIE (RM) approach could be rendered as a safe and efficient approach for locally advanced ESCC.This retrospective study was performed to compare outcomes in patients with locally advanced resectable ESCC undergoing RM, nCT plus MIE (CM) or [nCT plus open esophagectomy (OE)] (CO) approach and aims to illustrate the value of RM approach in treatment of locally advanced resectable ESCC. Methods PatientsBetween January 2010 to December 2016, patients completing neoadjuvant therapy followed by esophagectomy (n=194) were selected and their medical records were reviewed. The inclusion criteria were (I) thoracic ESCC; (II) McKeown or (III) Ivor-Lewi...

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Section: Discussionmentioning

confidence: 69%

mentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 87%

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Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?

et al. 2018

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“…In the oesophageal cancer group, 25% of the elderly patients received neoadjuvant therapy. Several studies show that neoadjuvant and combined chemoradiotherapy in patients with oesophageal and gastro‐oesophageal junction cancers tend to increase post‐operative morbidity, especially in patients with significant co‐morbid diseases or advanced age . The effect of neoadjuvant chemotherapy alone is more ambiguous, with some studies not showing any negative effects, while others report increased morbidity …”

Section: Discussionmentioning

confidence: 99%

Surgical outcomes of oesophagectomy or gastrectomy due to cancer for patients ≥75 years of age: a single‐centre cohort study

Klevebro

Garritano

Scandavini

et al. 2018

ANZ Journal of Surgery

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International benchmarking in oesophageal and gastric cancer surgery

et al. 2018

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BackgroundBenchmarking on an international level might lead to improved outcomes at a national level. The aim of this study was to compare treatment and surgical outcome data from the Swedish National Register for Oesophageal and Gastric Cancer (NREV) and the Dutch Upper Gastrointestinal Cancer Audit (DUCA).MethodsAll patients with primary oesophageal or gastric cancer who underwent a resection and were registered in NREV or DUCA between 2012 and 2014 were included. Differences in 30‐day mortality were analysed using case mix‐adjusted multivariable logistic regression.ResultsIn total, 4439 patients underwent oesophagectomy (2509 patients) or gastrectomy (1930 patients). Estimated resection rates were comparable. Swedish patients were older but had less advanced disease and less co‐morbidity than Dutch patients. Neoadjuvant treatment rates were lower in Sweden than in the Netherlands, both for patients who underwent oesophagectomy (68·6 versus 90·0 per cent respectively; P < 0·001) and for those having gastrectomy (38·3 versus 56·6 per cent; P < 0·001). In Sweden, transthoracic oesophagectomy was performed in 94·7 per cent of patients, whereas in the Netherlands, a transhiatal approach was undertaken in 35·8 per cent. Higher annual procedural volumes per hospital were observed in the Netherlands. Adjusted 30‐day and/or in‐hospital mortality after gastrectomy was statistically significantly lower in Sweden than in the Netherlands (odds ratio 0·53, 95 per cent c.i. 0·29 to 0·95).ConclusionFor oesophageal and gastric cancer, there are differences in patient, tumour and treatment characteristics between Sweden and the Netherlands. Postoperative mortality in patients with gastric cancer was lower in Sweden.

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Outcome of neoadjuvant therapies for cancer of the oesophagus or gastro-oesophageal junction based on a national data registry

Cited by 30 publications

References 37 publications

Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?

Neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy: is it a superior approach for locally advanced resectable esophageal squamous cell carcinoma?

Surgical outcomes of oesophagectomy or gastrectomy due to cancer for patients ≥75 years of age: a single‐centre cohort study

International benchmarking in oesophageal and gastric cancer surgery

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