Delayed Esophagectomy After Chemoradiation Is Not Associated With Increased Mortality or Recurrence

Objective

To evaluate the impact of delayed esophagectomy on the overall survival of esophageal cancer patients undergoing esophagectomy after CROSS.

Methods

A retrospective analysis was done of a prospective database of esophagectomy patients who underwent CROSS therapy and esophagectomy from May 2016 to January 2020. Preoperative characteristics, postoperative adverse events, recurrence rates, and survival rates were compared between patients who underwent surgery within 60 days of CROSS completion versus > 60 days.

Results

In total, 197 patients were included; 137 underwent surgery within 60 days (standard group, SG) versus 60 at > 60 days (delayed group, DG). Median time to surgery was 43 versus 76 days for the SG and DG groups. Median follow-up was 60 months. No differences were observed for gender, race, home state, Eastern Cooperative Oncology Group score, and tumor characteristics. DG patients were older; had higher Charlson Comorbidity Scores; and more history of myocardial infarction, stroke, and smoking, all p ≤ 0.05. DG had increased odds of major postoperative adverse events (odds ratio 2.26, 95% confidence interval 1.11–4.20). Overall survival and recurrence were similar.

Conclusion

Following CROSS, a delay in esophagectomy beyond 60 days was not associated with worse recurrence or overall survival despite increased comorbidities and postoperative events.