Timing of Surgery and Postoperative Outcomes in Esophagectomy for Squamous Cell Carcinoma: A Prospective Study in North India.

PURPOSE

Neoadjuvant chemotherapy followed by esophagectomy is the usual approach to manage esophageal squamous cell carcinoma (ESCC). The optimal interval to operate after completion of neoadjuvant chemoradiotherapy (NACRT) still remains controversial.

METHODS

A prospective study was conducted to observe and compare postoperative complications and pathological outcomes in patients with squamous cell carcinoma of the esophagus who underwent NACRT followed by surgery within 8 weeks or after 8 weeks of NACRT completion. The pathological complete response was assessed using the Mandard tumor regression grade. Morbidity and mortality were compared and were graded using the Clavien-Dindo scale.

RESULTS

The study included 50 patients, 19 patients in the < 8-week group and 31 in the > 8-week group study. Patients underwent thoracoscopy-assisted esophagectomy with neoesophagus formation using gastric conduit. There was a significant difference in mortality between the two groups, with three mortalities in the < 8-week group and none in the other group (p = 0.022). Postoperative complications and pathological outcomes did not have a statistically significant difference between the two groups.

CONCLUSION

The pathological response in ESCC cases does not appear to be impacted by the interval between NACRT and surgery; nevertheless, early surgery was associated with a higher risk of mortality.