Safety and feasibility of esophagectomy following combined immunotherapy and chemoradiotherapy for esophageal cancer
Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved..
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.
| Errataetall: |
CommentIn: J Thorac Cardiovasc Surg. 2021 Mar;161(3):844. - PMID 33454096 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:161 |
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| Enthalten in: |
The Journal of thoracic and cardiovascular surgery - 161(2021), 3 vom: 23. März, Seite 836-843.e1 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Sihag, Smita [VerfasserIn] |
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| Links: |
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| Themen: |
Chemoradiotherapy |
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| Anmerkungen: |
Date Completed 05.04.2021 Date Revised 30.03.2024 published: Print-Electronic CommentIn: J Thorac Cardiovasc Surg. 2021 Mar;161(3):844. - PMID 33454096 Citation Status MEDLINE |
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| doi: |
10.1016/j.jtcvs.2020.11.106 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 500 | |a CommentIn: J Thorac Cardiovasc Surg. 2021 Mar;161(3):844. - PMID 33454096 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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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| 650 | 4 | |a esophagectomy | |
| 650 | 4 | |a immunotherapy | |
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| 700 | 1 | |a Tan, Kay See |e verfasserin |4 aut | |
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| 700 | 1 | |a Jones, David R |e verfasserin |4 aut | |
| 700 | 1 | |a Molena, Daniela |e verfasserin |4 aut | |
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