Surgical Morbidity and Mortality From the Multicenter Randomized Controlled NeoRes II Trial Standard Versus Prolonged Time to Surgery After Neoadjuvant Chemoradiotherapy for Esophageal Cancer Show others and affiliations
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:liu:diva-173849 DOI: 10.1097/SLA.0000000000004340 ISI: 000619410000003 PubMedID: 32833767 OAI: oai:DiVA.org:liu-173849 DiVA, id: diva2:1535604
Note Funding Agencies|Swedish Cancer SocietySwedish Cancer Society; Region of Stockholm (ALF); Stockholm Cancer Society (Radiumhemmets forskningsfonder)
2021-03-092021-03-092021-03-09