TY - JOUR
T1 - Prolonged Time to Surgery in Patients with Residual Disease after Neoadjuvant Chemoradiotherapy for Esophageal Cancer
AU - Overtoom, Hidde C.G.
AU - Eyck, Ben M.
AU - Van Der Wilk, Berend J.
AU - Noordman, Bo J.
AU - Van Der Sluis, Pieter C.
AU - Wijnhoven, Bas P.L.
AU - Van Lanschot, J. Jan B.
AU - Lagarde, Sjoerd M.
AU - Doukas, Michail
AU - Van Der Gaast, Ate
AU - Mostert, Bianca
AU - Valkema, Roelf
AU - Spaander, Manon C.W.
AU - Nuyttens, Joost J.M.E.
AU - Coene, Peter Paul L.O.
AU - Hol, Lieke
AU - Courrech Staal, Ewout F.W.
AU - Kliffen, Mike
AU - Haberkorn, B. C.M.
AU - Dekker, Jan Willem T.
AU - Quispel, Rutger
AU - Ten Broek, M. R.J.
AU - Van Tilburg, A.
AU - Neelis, K. J.
AU - Heisterkamp, Joos
AU - Hazen, W. L.
AU - Vermeltfoort, I. A.C.
AU - Van Der Wurff, A. A.M.
AU - Beerepoot, L. V.
AU - Rozema, T.
AU - Kouwenhoven, Ewout A.
AU - Van Der Linde, A.
AU - Agool, A.
AU - Van Baarlen, J.
AU - Hoekstra, R.
AU - Hendriksen, E. M.
AU - Nieuwenhuijzen, Grard A.P.
AU - Schoon, Erik J.
AU - Roef, Mark J.
AU - Van Lijnschoten, Gisena
AU - Thijs, Annemarie M.J.
AU - Van Der Sangen, Maurice J.C.
AU - Pierie, Jean Pierre E.N.
AU - Corporaal, Sietske
AU - Balink, J. J.M.
AU - Nieken, Judith
AU - Edward Fiets, W.
AU - Oppedijk, V.
AU - Rosman, Camiel
AU - Buijsen, Jeroen
AU - Et al.
N1 - Publisher Copyright:
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2026/2
Y1 - 2026/2
N2 - Objective: – To investigate whether prolonged time to surgery negatively affects survival, pathologic outcome, or postoperative complications in patients with histologically proven residual disease after neoadjuvant chemoradiotherapy (nCRT) for locally advanced esophageal cancer. Background: – Historically, the standard time to surgery (TTS) has been 6 to 8 weeks after completion of nCRT. The effect of prolonged TTS is gaining interest, with contradicting results on survival and surgical morbidity. It can be hypothesized that, in patients with residual disease 6 weeks after completion of nCRT, prolonged TTS might be associated with worse survival and higher morbidity. Methods: – Patients with locally advanced esophageal cancer who had biopsy-proven residual disease 6 weeks after nCRT and underwent surgery, were categorized according to interval to surgery (TTS>12w vs TTS≤12w). The primary outcome of this study was overall survival. Secondary outcomes were disease-free survival, surgical outcomes, pathologic outcomes, and postoperative complications. Multivariable Cox regression was used for comparing survival and logistic regression for other outcomes, adjusted for the confounders age, cT, cN, Charlson comorbidity index, weight loss during nCRT, and WHO performance score after completion of nCRT. Results: – Forty patients were included for TTS>12w and 127 for TTS≤12w. TTS>12w was associated with better overall survival [adjusted hazard ratio (aHR) 0.46, 95% CI: 0.24–0.90], and disease-free survival (aHR 0.48, 95% CI: 0.24–0.94), but also with more postoperative respiratory complications (aOR 3.66, 95% CI: 1.52–9.59). Other outcomes were comparable between both groups. Conclusions: – Prolonged TTS in patients with histologically proven residual disease after completion of nCRT for esophageal cancer did not have a negative effect on overall and disease-free survival, but patients did have a higher risk for postoperative respiratory complications.
AB - Objective: – To investigate whether prolonged time to surgery negatively affects survival, pathologic outcome, or postoperative complications in patients with histologically proven residual disease after neoadjuvant chemoradiotherapy (nCRT) for locally advanced esophageal cancer. Background: – Historically, the standard time to surgery (TTS) has been 6 to 8 weeks after completion of nCRT. The effect of prolonged TTS is gaining interest, with contradicting results on survival and surgical morbidity. It can be hypothesized that, in patients with residual disease 6 weeks after completion of nCRT, prolonged TTS might be associated with worse survival and higher morbidity. Methods: – Patients with locally advanced esophageal cancer who had biopsy-proven residual disease 6 weeks after nCRT and underwent surgery, were categorized according to interval to surgery (TTS>12w vs TTS≤12w). The primary outcome of this study was overall survival. Secondary outcomes were disease-free survival, surgical outcomes, pathologic outcomes, and postoperative complications. Multivariable Cox regression was used for comparing survival and logistic regression for other outcomes, adjusted for the confounders age, cT, cN, Charlson comorbidity index, weight loss during nCRT, and WHO performance score after completion of nCRT. Results: – Forty patients were included for TTS>12w and 127 for TTS≤12w. TTS>12w was associated with better overall survival [adjusted hazard ratio (aHR) 0.46, 95% CI: 0.24–0.90], and disease-free survival (aHR 0.48, 95% CI: 0.24–0.94), but also with more postoperative respiratory complications (aOR 3.66, 95% CI: 1.52–9.59). Other outcomes were comparable between both groups. Conclusions: – Prolonged TTS in patients with histologically proven residual disease after completion of nCRT for esophageal cancer did not have a negative effect on overall and disease-free survival, but patients did have a higher risk for postoperative respiratory complications.
KW - esophageal cancer
KW - neoadjuvant chemoradiotherapy
KW - prolonged time to surgery
KW - residual disease
U2 - 10.1097/SLA.0000000000006488
DO - 10.1097/SLA.0000000000006488
M3 - Article
SN - 0003-4932
VL - 283
SP - 268
EP - 276
JO - Annals of Surgery
JF - Annals of Surgery
IS - 2
ER -