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Does Delayed Surgery Have an Impact on Outcome After Neoadjuvant Chemoradiotherapy (Nacrt) in Patients With Carcinoma Esophagus?
Rajesh Gupta*1, Sunil D. Shenvi1, Yalakanti R. Babu1, Saurabh Kalia1, Rajinder Singh1, Rakesh Kapoor2, Surinder S. Rana3, Deepak K. Bhasin3
1Surgical Gastroenterology Division, Postgraduate Institute of Medical Education and Research, Chandigarh, India; 2Radiation Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India; 3Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Objective: Esophagectomy is usually recommended within 4 to 6 weeks after completion of Neoadjuvant chemoradiotherapy (NACRT). However, because of various logistic factors, the surgery can get delayed. Aim of this study was to evaluate whether delayed surgery after NACRT affects postoperative outcomes in patients with locally advanced carcinoma esophagus.
Methods: From our prospectively maintained database, we retrospectively reviewed all patients who underwent Neoadjuvant chemoradiotherapy for resectable esophageal cancer between November 1999 and December 2010 at Division of surgical gastroenterology, Dept of General surgery, PGIMER, Chandigarh. Out of total 188 patients with carcinoma esophagus, 117 patients underwent Neoadjuvant chemoradiotherapy (NACRT).104 patients had squamous cell carcinoma (SCC) and 13 patients had adenocarcinoma (ADC). Mean interval between NACRT and surgery rest of the patients was 44.36days .Patients were divided into 3 groups on the basis of timing to surgery: group I, ≤30 days (n = 52); group II, 31to 60 days (n= 56); and group III, 61 to 90 days (n = 11). The Cox regression model and Kaplan-Meier plots were used to analyze the data.
Results: Groups were comparable in terms of patient and tumor characteristics. Difference in Overall survival and disease free survival in three groups of patient was not statistically significant. The Mean(±SD) and median(95%CI) overall survival in these three groups of patient was 34.9(6.9)months & 16(7-24)months, 42.2(8.24)months & 23 (12-33)months and 14.2(1.96)months & 12(9.3-14.6)months respectively(P = 0.6). The Mean(±SE) and median (95%CI) disease free survival in these three groups of patient was 31(6.73)months & 12(4-19)months,43(9,4)months&17(6-27)months and 18(2)months &10 months respectively(P = 0.2). Patients in group III had better relief in dysphagia, better weight gain and higher rates of pathological complete response without any significant increase in post operative complication and recurrence.
Conclusion: Delayed surgery after NACRT does not compromise the outcomes of patients with locally advanced carcinoma esophagus.
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