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Neoadjuvant chemoradiotherapy may increase the risk of severe anastomotic complications after esophagectomy with cervical anastomosis

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Abstract

Purpose

Neoadjuvant chemoradiotherapy (nCRT) improves long-term survival for patients with esophageal cancer. On the other hand, there are indications that nCRT may increase the risk for postoperative morbidity. The aims of this study were to estimate the radiation exposure to the site of anastomosis on the gastric fundus and to assess whether nCRT affected the incidence or severity of cervical anastomotic complications.

Methods

A retrospective cohort of patients with cancer of the esophagus or gastroesophageal junction, who were reconstructed with cervical anastomosis. The planned radiation dose to the site of the cervical anastomosis on the gastric fundus was estimated for each patient.

Results

The analysis of the dose plans showed that 20 out of 22 (93 %) available patients received radiotherapy toward the planned site of the anastomosis in the region of the gastric fundus with doses ranging from 6 to 40 Gy.

In the nCRT group, 12 out of 28 patients (43 %) had anastomotic complications compared to 16 out of 42 (38 %) in the non-RT group (p = 0.69). In the nCRT group, 39 % had anastomotic complications that led to a Clavien-Dindo grade of IVa or higher compared to 17 % in the non-RT group (p = 0.03). The OR for Clavien-Dindo grade IVa or worse was 6.0 (95 % CI 1.52–23.50).

Conclusion

This small retrospective study suggests that nCRT exposes the future anastomotic site to doses of radiation that may impair healing of the subsequent cervical anastomosis. Our data further suggest that nCRT may increase the severity of cervical anastomotic complications, and this hypothesis needs to be tested in a large prospective study.

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Acknowledgment

Dr. Huan Song for review of statistical methods.

Author contributions

Study design: MN, LL, IR, ML, JT, SF. Data analysis and interpretation: FK, MN, MH, LL, JT. Data acquisition: FK, MN, MH. Drafting of manuscript: FK and MN. Revision of manuscript: MN, LL, IR, ML, JT, SF, MH and FK.

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Authors and Affiliations

  1. Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden

    Fredrik Klevebro, Jon A. Tsai, Mats Lindblad, Ioannis Rouvelas, Lars Lundell & Magnus Nilsson

  2. Centre for Digestive Diseases, Karolinska University Hospital, K53 14186, Stockholm, Sweden

    Fredrik Klevebro

  3. Department of Oncology, Karolinska University Hospital, Stockholm, Sweden

    Signe Friesland & Mattias Hedman

Authors
  1. Fredrik Klevebro
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  2. Signe Friesland
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  6. Ioannis Rouvelas
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  8. Magnus Nilsson
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Corresponding author

Correspondence to Fredrik Klevebro.

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Funding

The study was financially supported by the Bengt Ihre fund, Swedish Society of Medicine. The sponsor had no influence in study design or interpretation of the data.

Conflict of interest

The authors have declared no conflicts of interest.

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Klevebro, F., Friesland, S., Hedman, M. et al. Neoadjuvant chemoradiotherapy may increase the risk of severe anastomotic complications after esophagectomy with cervical anastomosis. Langenbecks Arch Surg 401, 323–331 (2016). https://doi.org/10.1007/s00423-016-1409-0

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