Effects of preoperative chemoradiotherapy on postsurgical morbidity and mortality in cT3–4 +/− cM1lymph cancer of the oesophagus and gastro-oesophageal junction

Hagry, O.; Coosemans, W.; De Leyn, P.; Nafteux, P.; Van Raemdonck, D.; Van Cutsem, E.; Hausterman, K.; Lerut, T.
August 2003
European Journal of Cardio-Thoracic Surgery;Aug2003, Vol. 24 Issue 2, p179
Academic Journal
Objective: Very few studies have examined post-operative morbidity after resection of oesophageal carcinoma, especially in patients treated with induction chemo- and radiotherapy for locally advanced stages. This study assessed the effects of induction chemoradiotherapy on post-operative course after resection of locally advanced oesophageal carcinoma (cT3–4+cM1lymph). Methods: Induction therapy consisted of 5-fluorouracil days 1–5 and days 21–25, cisplatin day 1+day 21 and concomitant radiotherapy 18–20 fractions of 2 Gy (total dose 36–40 Gy). Induction chemoradiotherapy was completed in 109 patients. Surgery was performed in 90 patients (operability: 90/109=83%): 85 patients underwent resection with curative intent (resectability: 85/109=78%), bypass operation was performed in five patients. Nineteen patients could not be operated on. Results were compared to a matched group of pT3M1LYM/pT4 patients (n=86) who underwent primary surgery in the same period. Results: Resection was complete (R0) in 68 patients (68/90=76%). Mean duration of surgery was 428 min (range: 240–690). Peroperative complications were haemorrhage in three patients (3/90=3.3%), tracheobronchial perforation in three patients (3/90=3.3%). Median total hospital stay was 20.5 days (range: 8–355). Mean duration of intubation was 7 days (range: 1–190); 67 patients (67/90=74.4%) were intubated for less than 24 h. Non-tumour related hospital mortality after resection was 8.3% (7/84 patients). Mortality after two-field lymphadenectomy was 5.2 versus 11.7% after three-field lymphadenectomy. After primary surgery (n=86) overall mortality was 2.3% (P=0.015) and nil after two- and three-field lymphadenectomy (P=0.011). Medical morbidity consisted of pneumonia in 43 patients (43/90=48%), atelectasis in ten patients (10/90=11%), dysrhythmia in 21 patients (21/90=23%), sepsis in 11 patients (11/90=12%) and adult respiratory distress syndrome in ten patients (10/90=11%). Surgical morbidity included pleural effusion in 16 patients (16/90=18%), tracheal fistula in two patients (2/90=2%), chylothorax in two patients (2/90=2%) and acute pancreatitis in one patient (1/90=1%). Ten patients (10/90=11%) had a radiologically confirmed anastomotic leak; however only in four out of them with clinical manifestation; treatment was conservative in all four patients. Major morbidity occurred in 27 patients (27/90=30%). Overall rate of morbidity was significantly higher after three-field lymphadenectomy (85%) as compared to two-field lymphadenectomy (68.7%; P=0.023). Conclusions: Chemoradiotherapy followed by resection of cT3–4 +/− cM1lymph oesophageal carcinoma is feasible with acceptable mortality. Mortality, however, seems to be significantly higher when compared to a group of pT3M1LYM/pT4 patients who underwent primary surgery (8.3 versus 2.3%; P=0.015) in the same period in our department.


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