Effects of neoadjuvant chemoradiotherapy on postoperative morbidity and mortality associated with esophageal cancer

医学 食管切除术 食管癌 优势比 外科 置信区间 新辅助治疗 放化疗 内科学 肺炎 胃肠病学 癌症 化疗 乳腺癌
作者
Yoichi Hamai,Jun Hihara,Junya Taomoto,Ichiko Yamakita,Yuta Ibuki,Morihito Okada
出处
期刊:Diseases of The Esophagus [Oxford University Press]
卷期号:28 (4): 358-364 被引量:41
标识
DOI:10.1111/dote.12207
摘要

We compared the surgical outcomes between 114 patients who did not receive neoadjuvant therapy (group 1) and 92 others who received neoadjuvant chemoradiotherapy (nCRT) (group 2), and assessed the preoperative and surgical factors that influence postoperative morbidity to determine the impact of nCRT on morbidity and mortality after esophagectomy via cervical, right transthoracic, and abdominal approaches. The overall postoperative morbidity rates were 44.7% and 55.4% in groups 1 and 2, respectively (P = 0.13). Rates of anastomotic leak (8.8% vs. 16.3%; P = 0.10), pneumonia (9.6% vs. 13.0%; P = 0.44), recurrent nerve palsy (15.8% vs. 10.9%; P = 0.31), and all other complications did not significantly differ between the groups. Multivariable analysis revealed cervical lymph node dissection (odds ratio [OR], 1.97; 95% confidence interval [CI], 1.01–3.84; P = 0.047) as the sole independent covariate for overall morbidity. Furthermore, a history of cardiovascular disease (OR, 2.90; 95% CI, 1.03–8.24; P = 0.045), the retrosternal reconstruction route (OR, 15.15; 95% CI, 3.56–62.50; P = 0.0002), and a longer surgical duration (OR, 1.01; 95% CI, 1.002–1.02; P = 0.01) were independent covariates for anastomotic leakage, and advanced age (OR, 1.08; 95% CI, 1.01–1.15; P = 0.02) and lower body mass index (OR, 1.16; 95% CI, 1.01–1.33; P = 0.04) were independent covariates for pneumonia. However, whether or not patients received nCRT was irrelevant. We found that nCRT is safe for three-incision esophagectomy and it does not increase the incidence of postoperative morbidity and mortality relative to esophagectomy alone.
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