L R van der Werf1, J L Dikken2, E M van der Willik3, M I van Berge Henegouwen4, G A P Nieuwenhuijzen5, B P L Wijnhoven6. 1. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. 2. Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. 3. Department of Methodology, Dutch Institute for Clinical Auditing, Leiden, The Netherlands. 4. Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands. 5. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands. 6. Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands. Electronic address: B.wijnhoven@erasmusmc.nl.
Abstract
INTRODUCTION: The optimal time between end of neoadjuvant chemoradiotherapy (nCRT) and oesophagectomy is unknown. The aim of this study was to assess the association between this interval and pathologic complete response rate (pCR), morbidity and 30-day/in-hospital mortality. METHODS: Patients with oesophageal cancer treated with nCRT and surgery between 2011 and 2016 were selected from a national database: the Dutch Upper Gastrointestinal Cancer Audit (DUCA). The interval between end of nCRT and surgery was divided into six periods: 0-5 weeks (n = 157;A), 6-7 weeks (n = 878;B), 8-9 weeks (n = 972;C), 10-12 weeks (n = 720;D), 13-14 weeks (n = 195;E) and 15 or more weeks (n = 180;F). The association between these interval groups and outcomes was investigated using univariable and multivariable analysis with group C (8-9 weeks) as reference. RESULTS: In total, 3102 patients were included. The pCR rate for the groups A to F was 31%, 28%, 26%, 31%, 40% and 37%, respectively. A longer interval was associated with a higher probability of pCR (≥10 weeks for adenocarcinoma: odds ratio [95% confidence interval]: 1.35 [1.00-1.83], 1.95 [1.24-3.07], 1.64 [0.99-2.71] and ≥13 weeks for squamous cell carcinoma: 2.86 [1.23-6.65], 2.67 [1.29-5.55]. Patients operated ≥10 weeks after nCRT had the same probability for intraoperative/postoperative complications. Patients from groups D and F had a higher 30-day/in-hospital mortality (1.80 [1.08-3.00], 3.19 [1.66-6.14]). CONCLUSION: An interval of ≥10 weeks for adenocarcinoma and ≥13 weeks for squamous cell carcinoma between nCRT and oesophagectomy was associated with a higher probability of having a pCR. Longer intervals were not associated with intraoperative/postoperative complications. The 30-day/in-hospital mortality was higher in patients with extended intervals (10-12 and ≥15 weeks); however, this might have been due to residual confounding.
INTRODUCTION: The optimal time between end of neoadjuvant chemoradiotherapy (nCRT) and oesophagectomy is unknown. The aim of this study was to assess the association between this interval and pathologic complete response rate (pCR), morbidity and 30-day/in-hospital mortality. METHODS:Patients with oesophageal cancer treated with nCRT and surgery between 2011 and 2016 were selected from a national database: the Dutch Upper Gastrointestinal Cancer Audit (DUCA). The interval between end of nCRT and surgery was divided into six periods: 0-5 weeks (n = 157;A), 6-7 weeks (n = 878;B), 8-9 weeks (n = 972;C), 10-12 weeks (n = 720;D), 13-14 weeks (n = 195;E) and 15 or more weeks (n = 180;F). The association between these interval groups and outcomes was investigated using univariable and multivariable analysis with group C (8-9 weeks) as reference. RESULTS: In total, 3102 patients were included. The pCR rate for the groups A to F was 31%, 28%, 26%, 31%, 40% and 37%, respectively. A longer interval was associated with a higher probability of pCR (≥10 weeks for adenocarcinoma: odds ratio [95% confidence interval]: 1.35 [1.00-1.83], 1.95 [1.24-3.07], 1.64 [0.99-2.71] and ≥13 weeks for squamous cell carcinoma: 2.86 [1.23-6.65], 2.67 [1.29-5.55]. Patients operated ≥10 weeks after nCRT had the same probability for intraoperative/postoperative complications. Patients from groups D and F had a higher 30-day/in-hospital mortality (1.80 [1.08-3.00], 3.19 [1.66-6.14]). CONCLUSION: An interval of ≥10 weeks for adenocarcinoma and ≥13 weeks for squamous cell carcinoma between nCRT and oesophagectomy was associated with a higher probability of having a pCR. Longer intervals were not associated with intraoperative/postoperative complications. The 30-day/in-hospital mortality was higher in patients with extended intervals (10-12 and ≥15 weeks); however, this might have been due to residual confounding.
Authors: Ben M Eyck; Berend J van der Wilk; Bo Jan Noordman; Bas P L Wijnhoven; Sjoerd M Lagarde; Henk H Hartgrink; Peter Paul L O Coene; Jan Willem T Dekker; Michail Doukas; Ate van der Gaast; Joos Heisterkamp; Ewout A Kouwenhoven; Grard A P Nieuwenhuijzen; Jean-Pierre E N Pierie; Camiel Rosman; Johanna W van Sandick; Maurice J C van der Sangen; Meindert N Sosef; Edwin S van der Zaag; Manon C W Spaander; Roelf Valkema; Hester F Lingsma; Ewout W Steyerberg; J Jan B van Lanschot Journal: Trials Date: 2021-05-17 Impact factor: 2.279
Authors: S E Vollenbrock; F E M Voncken; J M van Dieren; D M J Lambregts; M Maas; G J Meijer; L Goense; S Mook; K J Hartemink; P Snaebjornsson; L C Ter Beek; M Verheij; B M P Aleman; R G H Beets-Tan; A Bartels-Rutten Journal: Br J Surg Date: 2019-02-25 Impact factor: 6.939
Authors: Scott C Fligor; Savas T Tsikis; Sophie Wang; Ana Sofia Ore; Benjamin G Allar; Ashlyn E Whitlock; Rodrigo Calvillo-Ortiz; Kevin Arndt; Mark P Callery; Sidhu P Gangadharan Journal: J Thorac Dis Date: 2020-11 Impact factor: 2.895
Authors: Alexander B J Borgstein; Stefanie Brunner; Wolfgang Schröder; Mark I van Berge Henegouwen; Masaru Hayami; Johnny Moons; Hans Fuchs; Wietse J Eshuis; Suzanne S Gisbertz; Christiane J Bruns; Philippe Nafteux; Magnus Nilsson Journal: Ann Surg Oncol Date: 2021-04-08 Impact factor: 5.344
Authors: F Klevebro; K Nilsson; M Lindblad; S Ekman; J Johansson; L Lundell; N Ndegwa; J Hedberg; M Nilsson Journal: Dis Esophagus Date: 2020-05-15 Impact factor: 3.429