Esophagectomy Timing After Neoadjuvant Therapy for Distal Esophageal Adenocarcinoma

Franko, Jan; Voynov, George; Goldman, Charles D.

doi:10.1016/j.athoracsur.2015.09.044

Cited by 43 publications

(26 citation statements)

References 15 publications

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“…10,11 In IGBC, to our knowledge, no study has examined the effect of the timing of reoperation after the initial cholecystectomy on outcomes. The purpose of this study was to assess the association of time interval from the initial cholecystectomy to reoperation with overall survival (OS).…”

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confidence: 99%

Association of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall Survival

Ethun

Postlewait

et al. 2017

JAMA Surg

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IMPORTANCE The current recommendation is to perform re-resection for select patients with incidentally discovered gallbladder cancer. The optimal time interval for re-resection for both patient selection and long-term survival is not known. OBJECTIVE To assess the association of time interval from the initial cholecystectomy to reoperation with overall survival. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted from January 1, 2000, to December 31, 2014 at 10 US academic institutions. A total of 207 patients with incidentally discovered gallbladder cancer who underwent reoperation and had available data on the date of their initial cholecystectomy were included. EXPOSURES Time interval from the initial cholecystectomy to reoperation: group A: less than 4 weeks; group B: 4 to 8 weeks; and group C: greater than 8 weeks. MAIN OUTCOMES AND MEASURES Primary outcome was overall survival. RESULTS Of 449 patients with gallbladder cancer, 207 cases (46%) were discovered incidentally and underwent reoperation at 3 different time intervals from the date of the original cholecystectomy: group A: less than 4 weeks (25 patients, 12%); B: 4 to 8 weeks (91 patients, 44%); C: more than 8 weeks (91 patients, 44%). The mean (SD) ages of patients in groups A, B, and C were 65 (9), 64 (11), and 66 (12) years, respectively. All groups were similar for baseline demographics, extent of resection, presence of residual disease, T stage, resection margin status, lymph node involvement, and postoperative complications. Patients who underwent reoperation between 4 and 8 weeks had the longest median overall survival (group B: 40.4 months) compared with those who underwent early (group A: 17.4 months) or late (group C: 22.4 months) reoperation (log-rank P = .03). Group A and C time intervals (vs group B), presence of residual disease, an R2 resection, advanced T stage, and lymph node involvement were associated with decreased overall survival on univariable Cox regression. Only group A (hazard ratio, 2.63; 95%CI, 1.25–5.54) and group C (hazard ratio, 2.07; 95%CI, 1.17–3.66) time intervals (vs group B), R2 resection (hazard ratio, 2.69; 95%CI, 1.27–5.69), and advanced T stage (hazard ratio, 1.85; 95%CI, 1.11–3.08) persisted on multivariable Cox regression analysis. CONCLUSIONS AND RELEVANCE The optimal time interval for re-resection for incidentally discovered gallbladder cancer appears to be between 4 and 8 weeks after the initial cholecystectomy.

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confidence: 99%

Association of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall Survival

Ethun

Postlewait

et al. 2017

JAMA Surg

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“…Optimal timing of surgery after neoadjuvant chemoradiotherapy has been explored for cancer of other organs such as rectal and esophageal cancers. 15,[17][18][19][20][21][22] Longer intervals in rectal cancer have been associated with increased tumor downstaging and higher rates of a complete pathologic response. 23 However, this advantage is counterbalanced by concerns of poor outcomes because of local tumor progression or the development of metastatic disease during the extended interval.…”

Section: Discussionmentioning

confidence: 99%

Implications of Prolonged Time to Pancreaticoduodenectomy After Neoadjuvant Chemoradiation

Teng

Nguyen

Bilchik

et al. 2020

Journal of Surgical Research

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“…In an effort not to exclude patients who received different radiotherapy regimens, the total dose of radiation was not limited. 10 In addition, given the limitation of the database capturing only surgical patients, there may be a subset whose disease progressed during the administration of induction therapy or who failed to receive resection because of treatment-related morbidity. Therefore, those who survived <4 months were also excluded to reduce a bias favoring the neoadjuvant therapy, considering that patients might receive surgery four to six weeks after the neoadjuvant therapy.…”

Section: Methodsmentioning

confidence: 99%

Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for clinical node‐negative esophageal carcinoma

et al. 2020

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Background The impact of neoadjuvant chemoradiotherapy (nCRT) on early stage esophageal cancer is unknown. Here, we compared the outcomes after esophagectomy alone or nCRT plus surgery for clinically staged node‐negative esophageal cancer. Methods We searched the Surveillance, Epidemiology, and End Results database for patients with clinically node‐negative (cN0) esophageal cancer from 2004 to 2016 who underwent surgery alone or nCRT plus surgery. Propensity score matching and Cox regression analysis were used to identify covariates associated with overall survival and cancer‐specific survival. Results A total of 1587 patients were retrospectively identified, of whom 49.8% (n = 791) received nCRT and 80.2% (n = 1273) were truly node‐negative diseases. For the entire cohort, surgery alone was associated with a statistically significant but modest absolute increase in survival outcomes (P < 0.01). After matching, nCRT was associated with improved five‐year overall survival for pT3‐4N0 (localized) disease (59.6% vs. 37.7%; P < 0.001) and pathological node‐positive disease (60.5% vs. 40.7%; P = 0.002). Cox multivariate regression analysis revealed that the addition of nCRT for truly node‐negative patients with tumor length ≥ 3 cm, pT1‐2N0 (early‐staged) and localized disease were independent risk factors for survival than surgery alone (P < 0.01). Conclusions Compared with surgery alone, patients with cN0 esophageal cancer with pathological node‐positive or localized true node‐negative disease gain a significant survival benefit from nCRT. However, nCRT plus surgery was associated with decreased survival for early‐staged true node‐negative patients. This finding may have significant implications on the use of neoadjuvant chemoradiation in patients with cN0 disease.

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Esophagectomy Timing After Neoadjuvant Therapy for Distal Esophageal Adenocarcinoma

Cited by 43 publications

References 15 publications

Association of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall Survival

Association of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall Survival

Implications of Prolonged Time to Pancreaticoduodenectomy After Neoadjuvant Chemoradiation

Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for clinical node‐negative esophageal carcinoma

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