Preoperative hiatal hernia in esophageal adenocarcinoma; does it have an impact on patient outcomes?

Background: The impact of hiatal hernia (HH) on oncologic outcomes of patients with esophageal adenocarci-noma (AC) remains unclear. The aim of this study was to assess the effect of pre-existing HH (>= 3 cm) on his-tologic response after neoadjuvant treatment (NAT), overall (OS) and disease-free survival (DFS). Methods: All consecutive patients with oncological esophagectomy for AC from 2012 to 2018 in our center were eligible for assessment. Categorical variables were compared with the X2 or Fisher's test, continuous ones with the Mann-Whitney-U test, and survival with the Kaplan-Meier and log-rank test.Results: Overall, 101 patients were included; 33 (32.7%) had a pre-existing HH. There were no baseline differ-ences between HH and non-HH patients. NAT was used in 81.8% HH and 80.9% non-HH patients (p = 0.910), most often chemoradiation (63.6% and 57.4% respectively, p = 0.423). Good response to NAT (TRG 1-2) was observed in 36.4% of HH versus 32.4% of non-HH patients (p = 0.297), whereas R0 resection was achieved in 90.9% versus 94.1% respectively (p = 0.551). Three-year OS was comparable for the two groups (52.4% in HH, 56.5% in non-HH patients, p = 0.765), as was 3-year DFS (32.7% for HH versus 45.6% for non-HH patients, p = 0.283).Conclusion: HH >= 3 cm are common in patients with esophageal AC, concerning 32.7% of all patients in this series. However, its presence was neither associated with more advanced disease upon diagnosis, worse response to NAT, nor overall and disease-free survival. Therefore, such HH should not be considered as risk factor that negatively affects oncological outcome after multimodal treatment of esophageal AC.

Automated summary

This study aimed to assess the impact of pre-existing hiatal hernia on histological response, overall survival, and disease-free survival in patients with esophageal adenocarcinoma after neoadjuvant treatment. The results showed that pre-existing hiatal hernia did not have a significant impact on histological response and survival rates in these patients.