Introduction: Recent studies cite a higher perioperative complication rate related to the use of neoadjuvant chemoradiotherapy in the treatment of esophageal cancer. We tested the hypothesis that neoadjuvant chemoradiotherapy has no significant effect on the complication rate at our institution.

Methods: We identified 170 (148 males-87%; 22 females-13%) patients with esophageal carcinoma who underwent esophagectomy between 1996 and 2002 from our prospective database. This included 73 (43%) patients treated with neoadjuvant chemoradiotherapy (group I) and 97 (57%) who underwent esophagectomy alone (group II). Neoadjuvant therapy consisted of a preoperative regimen of 2 courses of cisplatinum (day 1 and 28), continuous infusion of 5-FU, and radiation (5040cGy), followed by esophagectomy. Ivor-Lewis esophagectomy was performed in 161 (95%) and transhiatal in 9 (5%) cases. Groups I and II were comparable in terms of: age (61.1±11 years vs. 64.5±11); pathologic diagnosis (adenocarcinoma: 84% vs. 91%, squamous: 16% vs. 9%); and pathologic stage (AJCC): (stage I: 39% vs. 35%, IIa: 13%vs. 18%, 2b: 13% vs. 11%, III: 29% vs. 32%, and stage IV: 6% vs. 4%). The neoadjuvant group had 24 (33%) complete responses, 22 (30%) partial responses (where tumor size shrunk to at least 50% pre-treatment values via endoscopic ultrasound), and 27 (37%) non-responses.

Results: There were 40 (23.5%) postoperative complications for the entire cohort, which included 3 deaths (1.8%) (2 in group I and 1 in group II) and 4 anastomotic leaks (2.3%) demonstrated by routine gastrograffin swallow on postoperative day 7 (1 (1.4%) in group I vs. 3 (3.1%) in group II). Only one leak required reoperation (group I), while all others responded to conservative treatment. Group I had 14 (19.2%) complications versus 25 (25.7%) in group II (F-test=NS). The groups were comparable (group I vs. II) with respect to the rate of pneumonia (4.1% vs. 8.2%), arrhythmia (5.5% vs. 8.2%), and stricture formation (5.5% vs. 7.2%). Within the neoadjuvant group, complete responders were no less likely to have a complication than were nonresponders to preoperative chemoradiation (26% vs. 22%, respectively).

Conclusions: We conclude that the addition of neoadjuvant chemoradiotherapy in patients with esophageal cancer did not increase perioperative morbidity or mortality rates. In addition, a complete response to preoperative chemoradiotherapy did not affect perioperative complication rate.