Analysis of Carcinoma of the Esophagus Patients Between Upfront Surgery vs. Neoadjuvant Therapy Followed by Surgery

Abstract

In the management of carcinoma of the esophagus, neoadjuvant chemoradiation has shown to improve survival in many Western studies. It has still not become the standard of care in many centers due to perioperative morbidity/mortality or non-availability of infrastructure. We carried out a retrospective comparative study of patients undergoing upfront surgery (group A) versus patients undergoing radical esophagectomy after neoadjuvant therapy (group B) during the period 2015 to 2019 by a single surgical team in our hospital. A total of 55 cases were recorded. Baseline demographic parameters were similar between the groups. Perioperative outcomes like duration of surgery, blood loss, anastomotic leak, hospital stay, and postoperative complications were similar in both groups. There were no significant differences in radicality of resection, nodal harvest, and margin status. Pathologic complete response was observed in 20% who received neoadjuvant therapy. After a median follow-up of 28 months, 72% were alive in the upfront surgery arm and 50% in the neoadjuvant therapy arm. The mean overall survival was 10.9 ± 8.9 months in group A and 12.8 ± 10.8 months in group B. There was no statistically significant difference in survival between the groups (p value 0.503). Radical esophagectomy after neoadjuvant therapy is a feasible and safe oncologic procedure. Careful case selection and surgical expertise are important determinants in perioperative outcome. Prospective randomized controlled trials with long-term follow-up will establish the standard of care in this subset of population.