Surveillance may be safe in locally advanced esophageal cancer responsive to neoadjuvant chemoradiotherapy

  • van der Wilk BJ & al.
  • Ann Surg
  • 4 Oct 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • Active surveillance followed by salvage surgery led to similar survival and no increase in surgical complications compared with immediate surgery in patients with locally advanced esophageal cancer who had a complete clinical response after neoadjuvant chemoradiotherapy.
  • The study was small and needs to be confirmed by the large forthcoming SANO and ESOSTRATE randomized controlled trials.

Why this matters

  • Esophagectomy is associated with significant postoperative complications, which has generated interest in active surveillance as an alternative, but there has been concern that delay of surgery could lead to more postoperative complications.

Study design

  • Propensity score-matched, retrospective analysis (n=98; 31 active surveillance plus salvage surgery; 67 immediate surgery).
  • Active surveillance patients declined immediate surgery.
  • Funding: Dutch Cancer Foundation.

Key results

  • Median follow-up: active surveillance plus salvage surgery, 27.7 months; immediate surgery, 34.8 months.
  • Propensity score matching produced 2 groups of 29 (surveillance, surgery):
    • 3-year OS: 77% vs 55% (HR, 0.41; P=.104).
    • 3-year PFS: 60% vs 54% (HR, 1.08; P=.871).
    • Distant dissemination rate, 28% for both groups.
    • Radical resection rate, 100% for both groups.
    • Clavien-Dindo ≥3 postoperative complications (43% vs 45%).

Limitations

  • Retrospective, small population.