Division of Surgery & Cancer, Imperial College London, St Mary's Hospital, London, UK.
Gastrointestinal Unit, The Royal Marsden Hospital, 203 Fulham Road, London, UK.
BJS Open. 2022 Jan 6;6(1). doi: 10.1093/bjsopen/zrac003.
Perioperative FLOT (fluorouracil plus leucovorin, oxaliplatin, and docetaxel) chemotherapy is a recent regimen used to treat resectable oesophagogastric (OG) adenocarcinoma, associated with improved overall survival versus earlier chemotherapy strategies. This study compared short-term perioperative morbidity in a large tertiary centre series of FLOT to a matched cohort receiving ECX/ECF (epirubicin, cisplatin, capecitabine (X) or 5-fluorouracil (F)).
Consecutive patients completing four perioperative cycles of FLOT and proceeding to surgery with resectable OG adenocarcinoma were included. This was matched to patients from a historic ECX/ECF cohort from the same institution. A propensity score was calculated, and a secondary analysis using a propensity-matched group performed.
Cohorts were matched by tumour location and operations performed. In total there were 129 (64.5 per cent) oesophageal and 71 (35.5 per cent) gastric resections (FLOT 57 oesophageal, 43 gastric; ECF/ECX 64 oesophageal, 36 gastric). The median length of stay after surgery was 12 days in the FLOT group versus 15 in ECF/ECX (P = 0.035). There were no significant differences in overall perioperative complications and, specifically, no difference in OG anastomotic leaks, analysed by site (gastric (FLOT 0/79 (0 per cent) versus ECX 2/79 (2.5 per cent); P = 0.123), oesophageal (FLOT 4/121 (3.3 per cent) versus ECX 5/121 (4.1 per cent); P = 0.868) or type of surgery (open FLOT 1/121 (0.8 per cent) versus ECX 3/121 (2.5 per cent); P = 0.368; minimally invasive (FLOT 3/121 (2.5 per cent) versus ECX 2/121 (1.7 per cent); P = 0.555)). There was no statistical difference in leak-related return to theatre, 30-day (FLOT 0 (0 per cent) versus ECX 3/100 (3.0 per cent); P = 0.081), or 90-day (FLOT 0 (0 per cent) versus ECX 2/100 (2.0 per cent); P = 0.155) mortality.
In terms of surgical complications, FLOT and ECX/ECF were equally safe in patients undergoing resection for OG adenocarcinoma.
围手术期 FLOT（氟尿嘧啶加亚叶酸、奥沙利铂和多西他赛）化疗是一种最近用于治疗可切除的食管胃（OG）腺癌的方案，与早期化疗策略相比，总生存期有所改善。本研究比较了 FLOT 在大型三级中心系列中的短期围手术期发病率与接受 ECX/ECF（表柔比星、顺铂、卡培他滨（X）或 5-氟尿嘧啶（F））的匹配队列。
纳入了完成四个围手术期 FLOT 周期并接受可切除 OG 腺癌手术的连续患者。这与来自同一机构的历史 ECX/ECF 队列中的患者相匹配。计算了倾向评分，并对使用倾向评分匹配组进行了二次分析。
两组按肿瘤部位和手术方式相匹配。共有 129 例（64.5%）食管和 71 例（35.5%）胃切除术（FLOT 57 例食管，43 例胃；ECX/ECF 64 例食管，36 例胃）。FLOT 组术后中位住院时间为 12 天，ECX/ECF 组为 15 天（P=0.035）。总体围手术期并发症无显著差异，特别是 OG 吻合口漏的发生率无差异，按部位分析（胃（FLOT 0/79（0%）与 ECX 2/79（2.5%）；P=0.123），食管（FLOT 4/121（3.3%）与 ECX 5/121（4.1%）；P=0.868）或手术类型（开放 FLOT 1/121（0.8%）与 ECX 3/121（2.5%）；P=0.368；微创（FLOT 3/121（2.5%）与 ECX 2/121（1.7%）；P=0.555）。吻合口相关再次手术的漏相关 30 天（FLOT 0（0%）与 ECX 3/100（3.0%）；P=0.081）和 90 天（FLOT 0（0%）与 ECX 2/100（2.0%）；P=0.155）死亡率无统计学差异。
在接受 OG 腺癌切除术的患者中，FLOT 和 ECX/ECF 的手术并发症同样安全。
