Journal
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
Volume 161, Issue 3, Pages 836-842Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2020.11.106
Keywords
esophagectomy; immunotherapy; chemoradiotherapy; esophageal cancer
Funding
- National Institutes of Health/National Cancer Institute Cancer Center [P30 CA008748]
- Fiona and Stanley Druckenmiller Center for Lung Cancer Research at Memorial Sloan Kettering Cancer Center
- David J. Sugarbaker Research Scholarship from the American Association for Thoracic Surgery
- National Institutes of Health/National Cancer Institute [R01CA217169, R01CA240472]
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Esophagectomy following neoadjuvant immunotherapy and standard chemoradiotherapy for locally advanced esophageal cancer appears to be safe and feasible based on the preliminary experience. There were no significant differences in major complications risk, interval to surgery, and 30-day mortality between the two groups.
Objectives: We sought to determine the safety and feasibility of esophagectomy after neoadjuvant immunotherapy and chemoradiotherapy in clinical trial patients with locally advanced esophageal cancer. Methods: We retrospectively identified patients who were treated with neoadjuvant immunotherapy and chemoradiotherapy (n = 25) or chemoradiotherapy alone (n = 143) at our institution between 2017 and 2020. The primary end point was risk of 30-day major complications (Clavien-Dindo classification system grade >= 3), which was assessed between groups using a multivariable log-binomial regression model to obtain adjusted relative risk ratios. Secondary end points were interval to surgery, 30-day readmission rate, and 30-day mortality. Results: All included patients successfully completed neoadjuvant therapy and underwent esophagectomy with negative margins. Age, sex, performance status, clinical stage, histologic subtype, procedure type, and operative approach were similar between groups. Neoadjuvant immunotherapy was not associated with a statistically significantly increased risk of developing a major pulmonary (relative risk, 1.43; 95% confidence interval, 0.53-3.84; P = .5), anastomotic (relative risk, 1.34; 95% confidence interval, 0.45-3.94; P = .6), or other complication (relative risk, 1.29; 95% confidence interval, 0.26-6.28; P = .8). Median (interquartile range) interval to surgery was 54 days (47-61 days) in the immune checkpoint inhibitor group versus 53 days (47-66 days) in the control group (P = .6). Minimally invasive approaches were successful in 72% of cases, with only 1 conversion. Thirty-day mortality and readmission rates were 0% and 17%, respectively, in the immune checkpoint inhibitor group and 1.4% and 13%, respectively, in the control group. Conclusions: On the basis of our preliminary experience, esophagectomy appears to be safe and feasible following combined neoadjuvant immunotherapy and standard chemoradiotherapy for locally advanced esophageal cancer.
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