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Impact of Delaying Surgery After Chemoradiation on Outcomes for Locally Advanced Esophageal Squamous Cell Carcinoma

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Performing selective esophagectomy for locally advanced squamous cell carcinoma may spare patients morbidity, but delayed surgery may infer higher risks. This study evaluated the impact of length of time between chemoradiation and esophagectomy on perioperative outcomes and long-term survival.

Methods

The impact of surgical timing, stratified by surgery performed < 180 and ≥ 180 days from starting radiation, on perioperative outcomes and survival in patients treated with chemoradiation and esophagectomy for cT1N + M0 and cT2–4, any N, M0 squamous cell carcinoma of the mid-distal esophagus in the National Cancer Database (2006–2016) was evaluated with logistic regression, Kaplan–Meier curves, Cox proportional-hazards methods, and propensity-matched analysis.

Results

Median time between starting radiation and esophagectomy in 1641 patients was 93 (IQR 81–114) days. Most patients (96.8%, n = 1589) had surgery within 180 days of starting radiation, while 52 patients (3.2%) had delayed surgery. Black race and clinical T stage were associated with delayed surgery. Rates of pathologic upstaging, downstaging, complete response, and positive margins were not significantly different between the groups. Patients with delayed surgery had increased major morbidity as measured by a composite of length of hospital stay, readmission, and 30-day mortality [42.3% (22/52) vs 22.3% (355/1589), p = 0.001]. However, delayed surgery was not associated with a significant difference in survival in both univariate [5-year survival 32.8% (95% CI 21.1–50.7) vs 47.3% (44.7–50.1), p = 0.19] and multivariable analysis [hazard ratio (HR) 1.23 (0.85–1.78), p = 0.26].

Conclusions

Delaying surgery longer than 180 days after starting chemoradiation for esophageal squamous cell carcinoma is associated with worse perioperative outcomes but not long-term survival.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Falk Cardiovascular Research Institute, Stanford University, Stanford, CA, USA

    Lye-Yeng Wong MD, Douglas Z. Liou MD, Leah M. Backhus MD, MPH, Natalie S. Lui MD, Joseph B. Shrager MD & Mark F. Berry MD

  2. Department of Radiation Oncology, Stanford University, Stanford, CA, USA

    Lucas K. Vitzthum MD & Daniel Chang MD

  3. VA Palo Alto Health Care System, Palo Alto, CA, USA

    Leah M. Backhus MD, MPH, Joseph B. Shrager MD & Mark F. Berry MD

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Wong, LY., Liou, D.Z., Vitzthum, L.K. et al. Impact of Delaying Surgery After Chemoradiation on Outcomes for Locally Advanced Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 30, 2212–2223 (2023). https://doi.org/10.1245/s10434-022-12980-5

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