Berend J van der Wille1, Bo J Noordman1, Lisanne K A Neijenhuis1, Daan Nieboer2, Grard A P Nieuwenhuijzen3, Meindert N Sosef4, Mark I van Berge Henegouwen5, Sjoerd M Lagarde1, Manon C W Spaander6, Roelf Valkema7, Katharina Biermann8, Bas P L Wijnhoven1, Ate van der Gaast9, J Jan B van Lanschot1, Michael Doukas8, Suzan Nikkessen6, Misha Luyer3, Erik J Schoon10, Mark J Roef11, Ineke van Lijnschoten12, Liekele E Oostenbrug13, Robert G Riedl14, Suzanne S Gisbertz5, Kausilia K Krishnadath15, Roel J Bennink16, Sybren L Meijer17. 1. Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. 2. Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands. 3. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. 4. Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands. 5. Department of Surgery, Amsterdam University Medical Centers-location AMC, University of Amsterdam, Amsterdam Cancer Center, Amsterdam, the Netherlands. 6. Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands. 7. Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands. 8. Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands. 9. Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, the Netherlands. 10. Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, the Netherlands. 11. Department of Radiology and Nuclear Medicine, Catharina Hospital, Eindhoven, the Netherlands. 12. Department of Pathology, PAMM - Eindhoven, the Netherlands. 13. Department of Gastroenterology & Hepatology, Zuyder- land Medical Center, Heerlen, the Netherlands. 14. Department of Pathology, Zuyderland Medical Center, Heerlen, the Netherlands. 15. Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers - location AMC, University of Amsterdam, Amsterdam Cancer Center, Amsterdam, the Netherlands. 16. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers - location AMC, University of Amsterdam, Amsterdam Cancer Center, Amsterdam, the Netherlands. 17. Department of Pathology, Amsterdam University Medical Centers - location AMC, University of Amsterdam, Amsterdam Cancer Center, Amsterdam, the Netherlands.
Abstract
OBJECTIVE: This study compared outcomes of patients with esophageal cancer and clinically complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT) undergoing active surveillance or immediate surgery. BACKGROUND: Since nearly one-third of patients with esophageal cancer show pathologically complete response after nCRT according to CROSS regimen, the oncological benefit of immediate surgery in cCR is topic of debate. METHODS: Patients with cCR based on endoscopic biopsies and endoscopic ultrasonography with fine-needle aspiration initially declining or accepting immediate surgery after nCRT were identified between 2011 and 2018. Primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), rate and timing of distant dissemination, and postoperative outcomes. RESULTS: Some 98 patients with cCR were identified: 31 in the active surveillance- and 67 in the immediate surgery group with median followup of survivors of 27.7 and 34.8 months, respectively. Propensity score matching resulted in 2 comparable groups (n = 29 in both groups). Patients undergoing active surveillance or immediate surgery had a 3-year OS of 77% and 55% (HR 0.41; 95% CI 0.14-1.20, P = 0.104), respectively. The 3-year PFS was 60% and 54% (HR 1.08; 95% CI 0.44-2.67, P = 0.871), respectively. Patients undergoing active surveillance or immediate surgery had a comparable distant dissemination rate (both groups 28%), radical resection rate (both groups 100%), and severity of postoperative complications (Clav- ien-Dindo grade ≥ 3: 43% vs 45%, respectively). CONCLUSION: In this retrospective study, OS and PFS in patients with cCR undergoing active surveillance or immediate surgery were not significantly different. Active surveillance with postponed surgery for recurrent disease was not associated with a higher distant dissemination rate or more severe adverse postoperative outcomes.
OBJECTIVE: This study compared outcomes of patients with esophageal cancer and clinically complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT) undergoing active surveillance or immediate surgery. BACKGROUND: Since nearly one-third of patients with esophageal cancer show pathologically complete response after nCRT according to CROSS regimen, the oncological benefit of immediate surgery in cCR is topic of debate. METHODS: Patients with cCR based on endoscopic biopsies and endoscopic ultrasonography with fine-needle aspiration initially declining or accepting immediate surgery after nCRT were identified between 2011 and 2018. Primary endpoint was overall survival (OS). The secondary endpoints were progression-free survival (PFS), rate and timing of distant dissemination, and postoperative outcomes. RESULTS: Some 98 patients with cCR were identified: 31 in the active surveillance- and 67 in the immediate surgery group with median followup of survivors of 27.7 and 34.8 months, respectively. Propensity score matching resulted in 2 comparable groups (n = 29 in both groups). Patients undergoing active surveillance or immediate surgery had a 3-year OS of 77% and 55% (HR 0.41; 95% CI 0.14-1.20, P = 0.104), respectively. The 3-year PFS was 60% and 54% (HR 1.08; 95% CI 0.44-2.67, P = 0.871), respectively. Patients undergoing active surveillance or immediate surgery had a comparable distant dissemination rate (both groups 28%), radical resection rate (both groups 100%), and severity of postoperative complications (Clav- ien-Dindo grade ≥ 3: 43% vs 45%, respectively). CONCLUSION: In this retrospective study, OS and PFS in patients with cCR undergoing active surveillance or immediate surgery were not significantly different. Active surveillance with postponed surgery for recurrent disease was not associated with a higher distant dissemination rate or more severe adverse postoperative outcomes.
Authors: Jonathan Spoor; Ben M Eyck; Peggy N Atmodimedjo; Maurice P H M Jansen; Jean C A Helmijr; John W M Martens; Berend J van der Wilk; J Jan B van Lanschot; Winand N M Dinjens Journal: Ann Transl Med Date: 2021-08
Authors: Maria J Valkema; Berend J van der Wilk; Ben M Eyck; Bas P L Wijnhoven; Manon C W Spaander; Michail Doukas; Sjoerd M Lagarde; Wendy M J Schreurs; Mark J Roef; J Jan B van Lanschot; Roelf Valkema Journal: J Nucl Med Date: 2020-09-04 Impact factor: 11.082
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: Brett S Walker; Thomas L Sutton; Luai Zarour; John G Hunter; Stephanie G Wood; V Liana Tsikitis; Daniel O Herzig; Charles D Lopez; Emerson Y Chen; Skye C Mayo; Melissa H Wong Journal: Ann Surg Oncol Date: 2021-08-07 Impact factor: 5.344
Authors: B J van der Wilk; B M Eyck; M Doukas; M C W Spaander; E J Schoon; K K Krishnadath; L E Oostenbrug; S M Lagarde; B P L Wijnhoven; L H J Looijenga; K Biermann; J J B van Lanschot Journal: Br J Surg Date: 2020-08-05 Impact factor: 6.939