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Influence of Neoadjuvant Therapy on Poor Long-Term Outcomes of Postoperative Complications in Patients with Esophageal Squamous Cell Carcinoma: A Retrospective Cohort Study

Annals of Surgical Oncology volume 26, pages 2081–2089 (2019)Cite this article

Abstract

Background

Postoperative complications have a negative impact on overall survival after esophagectomy because systemic inflammation may induce residual cancer cell growth. A solution that could suppress micrometastasis is neoadjuvant therapy; however, to date, no study has shown that neoadjuvant therapy suppresses proliferation of cancer cells due to postoperative complications after esophagectomy. The aim of this study is to investigate the influence of neoadjuvant therapy on poor long-term outcomes of postoperative complications in patients with esophageal carcinoma.

Patients and Methods

In total, 431 patients who underwent esophagectomy for esophageal squamous cell carcinoma were included in this study. We investigated the relationship between complications, such as pneumonia, and long-term oncologic outcomes with and without neoadjuvant therapy.

Results

Among the patients, the 3-year overall survival (OS) rate was 69.5% and the disease-free survival (DFS) rate was 59.0%. The patients were categorized into two groups: the neoadjuvant therapy (+) group (n = 217) and neoadjuvant therapy (−) group (n = 214). Among patients not undergoing neoadjuvant therapy, patients with pneumonia or pyothorax had significantly poorer OS and DFS than patients without these complications. However, among patients undergoing neoadjuvant therapy, there were no significant differences in long-term outcomes, regardless of presence of complications. On multivariate analysis, pneumonia (p = 0.003), pyothorax (p < 0.001), and chylothorax (p = 0.002) were identified as predictors of death in the neoadjuvant therapy (−) group.

Conclusion

The negative impact of postoperative complications on long-term prognoses can be reduced by performing neoadjuvant therapy in patients with esophageal carcinoma.

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Acknowledgment

The authors thank Kumiko Motooka, a staff member at the Department of Surgery in Keio University School of Medicine, for help in preparation of the manuscript.

Funding

Yuko Kitagawa reports personal fees from ETHICON PART OF JOHNSON AND JOHNSON FAMILY OF COMPANIES, grants from KYOWA HAKKO KIRIN CO., LTD, personal fees from Medtronic Japan Co., Ltd., outside the submitted work.

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Affiliations

  1. Department of Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan

    Masashi Takeuchi MD, Hirofumi Kawakubo MD, PhD, Shuhei Mayanagi MD, PhD, Tomoyuki Irino MD, PhD, Kazumasa Fukuda PhD, Rieko Nakamura MD, PhD, Norihito Wada MD, PhD, Hiroya Takeuchi MD, PhD & Yuko Kitagawa MD, PhD

  2. Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Hiroya Takeuchi MD, PhD

Authors
  1. Masashi Takeuchi MD
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  2. Hirofumi Kawakubo MD, PhD
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  3. Shuhei Mayanagi MD, PhD
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  4. Tomoyuki Irino MD, PhD
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  5. Kazumasa Fukuda PhD
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  6. Rieko Nakamura MD, PhD
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  7. Norihito Wada MD, PhD
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  8. Hiroya Takeuchi MD, PhD
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  9. Yuko Kitagawa MD, PhD
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Corresponding author

Correspondence to Hirofumi Kawakubo MD, PhD.

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Supplemental Figure 1

Kaplan–Meier curves for disease-free survival (DFS) associated with pneumonia in the (A-1) neoadjuvant therapy (+) group and (A-2) neoadjuvant therapy (−) group; Kaplan–Meier curves for cancer-specific survival (CSS) associated with pneumonia in the (B-1) neoadjuvant therapy (+) group and (B-2) neoadjuvant therapy (−) group. Red and blue lines indicate groups with and without pneumonia, respectively (TIFF 332 kb)

Supplementary material 2 (DOCX 34 kb)

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Takeuchi, M., Kawakubo, H., Mayanagi, S. et al. Influence of Neoadjuvant Therapy on Poor Long-Term Outcomes of Postoperative Complications in Patients with Esophageal Squamous Cell Carcinoma: A Retrospective Cohort Study. Ann Surg Oncol 26, 2081–2089 (2019). https://doi.org/10.1245/s10434-019-07312-z

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  • DOI: https://doi.org/10.1245/s10434-019-07312-z