Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers

Kumagai, Koshi; Rouvelas, Ioannis; Tsai, Jon A.; Mariosa, Daniela; Klevebro, Fredrik; Lindblad, Mats; Ye, W; Lundell, Lars; Nilsson, Magnus

doi:10.1002/bjs.9418

Cited by 194 publications

(160 citation statements)

References 59 publications

(139 reference statements)

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“…Esophageal cancer (EC) is one of the most malignant gastrointestinal cancers worldwide (1,2). Neoadjuvant therapy followed by surgery is the standard treatment for patients with resectable thoracic esophageal squamous cell carcinoma (ESCC) (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation

et al. 2016

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Background: To map detail distribution of metastatic supraclavicular (SCV) lymph nodes (LN) in esophageal cancer (EC) patients and determine the precise radiation therapy clinical target volume (CTV).Methods: A total of 101 thoracic esophageal carcinoma patients after surgery experienced SCV LN metastasis were retrospectively examined. The SCV region is further divided into four subgroups. Using hand drawings registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution. Results: In all, 158 nodes were considered to be clinical metastatic in the SCV region in the 101 patients, 74 on the left and 84 on the right. Seven of 158 (4.4%) positive LN were located in group I, 78 of 158 (49.37%) were located in group II, 72 of 158 nodes (45.6%) were located in group III, 1 of 158 (0.63%) located in group IV. Conclusions: According to our results, the SCV group II and group III are considered to be the high risk regions of esophageal squamous cell carcinoma (ESCC) LN metastasis, which were defined as elective nodal irradiation (ENI) areas. was the most common site of recurrence regardless of the tumor location. Even among patients with lower thoracic ESCC, the incidence of SCV LN recurrence was as high as 33.8%. Similar to finding of Wu and colleagues, Cai et al. (6) performed a study to investigate the patterns of regional LN recurrence after radical surgery for ESCC. The results showed that SCV areas were the most common site of recurrence, followed by mediastinal and abdominal areas. As such, several studies also indicated that the incidence of SCV LN recurrence was a common site of recurrence after radical surgery (range, 33.3% to 75.0%) (7-9). The available data indicates that postoperative radiotherapy could reduce locoregional recurrence and improve overall survival of ESCC patients. Furthermore, the major of studies suggested that the SCV areas should be included in prophylactic radiotherapy for patients with upper, middle, and lower thoracic EC (6,(11)(12)(13).However, delineating the SCV region lymph nodal clinical target volume (CTVn) for esophageal carcinoma remains a challenging task. Currently, data documenting the precise location of involved SCV region LN in esophageal carcinoma are scarce. It is desirable to define detailed involvement patterns in the SCV region, so that these areas can be better covered and treated with an adequate radiation dose. Here, we describe the distribution of SCV LN metastasis for esophageal carcinoma patient after surgery according to computed tomography (CT) imaging in our institution, then analyzed the anatomic distribution of SCV region LN to outline the spatial and probabilistic distributions of LN, and to provide data for an evidence-based approach to SCV region radiation therapy field design. Thus, we could minimize inconsistency of irradiation field and to achieve precise radiotherapy of the SCV region for postoperative radiotherapy. Methods Patient populationWe retrospectively reviewed the...

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Section: Introductionmentioning

confidence: 99%

Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation

et al. 2016

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“…What was notable was that all of the six patients with leakage had undergone NCRT and cervical anastomosis. Some studies suggested that NCRT was a risk factor for morbidities and mortalities (19,20), while some others hold the opposed idea (21)(22)(23). A retrospective study from our center reported that cervical leakage occurred more frequently than intrathoracic leakage (23.6%, 145/615 vs. 5.0%, 101/2,023, P<0.001) (24).…”

Section: Discussionmentioning

confidence: 86%

Results of neoadjuvant therapy followed by esophagectomy for patients with locally advanced thoracic esophageal squamous cell carcinoma

Lin

et al. 2017

J. Thorac. Dis.

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Background: For patients diagnosed with locally advanced esophageal cancer, neoadjuvant therapy followed by surgery is the most common approach. However, randomized trials resulted in inconsistent conclusions. We conducted this retrospective study to evaluate the influence of neoadjuvant therapy on postoperative events and the influence on disease-free survival (DFS) and overall survival (OS). Methods:We retrospectively reviewed all of the patients underwent surgery following neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma (ESCC) during January 1st, 2013 and December 31st, 2015 in Fudan University Shanghai Cancer Center (FUSCC). Prognostic factors for DFS and OS were identified by univariate and multivariate analyses.Results: A total of fifty patients were included. Regarding postoperative morbidities, pneumonia and leakage occurred in 9 (18.0%) and 6 (12.0%) patients, respectively. For the whole patients, the 1-, 2-, 3-year DFS and OS rates were 57.0%, 48.0%, 42.0% and 86.0%, 73.0%, 62.0%, respectively. Lung metastasis and mediastinal node involvement were the most common relapse patterns. Univariate and multivariate analyses confirmed ypTNM stage as an independent prognostic factor for both DFS and OS; while leakage was an independent prognostic factor for DFS. Conclusions: Neoadjuvant therapy did not increase postoperative morbidities but did achieve favorable survival. The ypTNM stage was an independent prognostic factor for both DFS and OS. Long-term survival needs further investigation.

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“…1,52 At the same time, neoadjuvant chemotherapy has not been shown to increase anastomotic leak rate in esophageal surgery. [53][54][55] Although logically, one would assume there would be an association between neoadjuvant therapy and anastomotic leak, to date, there is no consensus about this relationship.…”

Section: Steroids/immune Modulatorsmentioning

confidence: 99%

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

Phillips¹

2016

OAS

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Various techniques and interventions have been developed in an effort to obviate gastrointestinal anastomotic leaks. This review is intended to delineate potential modifications that can be made to reduce the risk of anastomotic leaks following gastrointestinal surgery. It may also serve to aid in identifying patients who are at increased risk of anastomotic leak. Modifiable risk factors for leak discussed include malnutrition, smoking, steroid use, bowel preparation, chemotherapy, duration of surgery, use of pressors, intravenous fluid administration, blood transfusion, and surgical anastomotic technique. Based upon literature review, operative techniques should include minimizing operative time, reducing ischemia, and utilizing stapled anastomoses. Buttressing of anastomoses with omentum has proven utility for esophageal surgery. Further recommendations include 5-7 days of immune-modifying nutritional supplementation for malnourished patients, discontinuation of smoking in the perioperative period, limiting steroid use, utilization of oral antibiotic preparation for colorectal surgery, avoidance of early operations (,4 weeks) following chemotherapy, limiting pressor use, and the utilization of goal-directed fluid management.

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Meta-analysis of postoperative morbidity and perioperative mortality in patients receiving neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal and gastro-oesophageal junctional cancers

Cited by 194 publications

References 59 publications

Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation

Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation

Results of neoadjuvant therapy followed by esophagectomy for patients with locally advanced thoracic esophageal squamous cell carcinoma

Reducing gastrointestinal anastomotic leak rates: review of challenges and solutions

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