No overall survival cost to surgical delay in esophageal adenocarcinoma

  • Levinsky NC & al.
  • J Thorac Cardiovasc Surg
  • 22 Oct 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Delayed vs timely esophagectomy was associated with increased perioperative mortality, but not OS, after chemoradiation for clinical stage II/III esophageal adenocarcinoma.

Why this matters

  • Delayed and salvage esophagectomy have been found to be associated with worse outcomes in previous studies, but this study showed worse outcomes only in perioperative survival.

Study design

  • Retrospective analysis of 8489 records from the National Cancer Database.
  • Funding: None disclosed.

Key results

  • 92.1% of patients underwent timely esophagectomy (
  • Median post-CRT surgical delay was 49 days in the timely esophagectomy group and 109 days in the delayed group.
  • The delayed group was more likely to be black (2.3% vs 1.2%; P=.007) and to be on Medicare (47.9% vs 39.8%; P<.001 chemotherapy regimens radiation dose and surgical approach were similar between the groups.>
  • Pathological complete response was more frequent in the delayed group (22.2% vs 18.6%; P=.043).
  • 90-day postoperative mortality was higher in the delayed group (10.4% vs 7.8%; P<.005 but there was no difference in os with either a delay or>120 days delay.

Limitations

  • Retrospective analysis.