Safety And Effectiveness of Radical Esophagectomy After Neoadjuvant Chemotherapy For Resectable Locally Advanced Esophageal Cancer

Abstract

Background: Patients with locally advanced esophageal cancer (LAEC) have a poor prognosis and require a multimodal treatment. However, there are still debates on the optimal strategy in the treatment of LAECs. This study was to evaluate short-term and oncological outcomes of radical esophagectomy after neoadjuvant chemotherapy (nCT) in patients with LAEC.

Methods: This retrospective study was performed between July 2019 and December 2020. A total of 69 patients with LAECs underwent thoraco-laparoscopic McKeown esophagectomy with three-field lymphadenectomy after a complete nCT with DCX (docetaxel-cisplatin-capecitabine, 67 patients) or DCF regimen (docetaxel-cisplatin-fluorouracil, two patients). Short-term outcomes included clinical and pathologic response according to the Response Evaluation Criteria in Solid Tumor version 1.1, treatment-related adverse events (TRAEs) assessed using the National Cancer Institute-Common Toxicity Criteria for Adverse Events, and postoperative complications graded by Clavien-Dindo classification. Oncological outcomes included overall survival (OS) and disease-free survival (DFS) during following up.

Results: All patients were male and had squamous cell carcinoma: 22 with stage III and 47 with stage IVa at baseline. There were 67 patients (97.1%) with clinical complete response and 65 patients (94.2%) with tumor downstaging after nCT. Grade 3-4 TRAEs occurred in five patients (7.2%). All patients received an R0 resection; 37 (53.6%) had postoperative complications but only three (4.3%) were classified as grade III according to Clavien-Dindo classification. Two-year OS and DFS (95% confidence interval) were 78% (67-92%) and 72% (61-86%) respectively.

Conclusions: Radical esophagectomy after nCT is safe and can improve oncological outcomes for patients with LAECs.