RADIATION DOSE IS NOT ASSOCIATED WITH THE SEVERITY OF ANASTOMOTIC STENOSIS AFTER NEOADJUVANT CHEMORADIOTHERAPY AND SURGICAL RESECTION IN ESOPHAGEAL AND GASTROESOPHAGEAL JUNCTION CARCINOMA

 

Aims In the Netherlands, neoadjuvant chemoradiotherapy (nCRT) has become standard treatment for non-metastic resectable esophageal cancer as it increases survival compared to surgery alone. Stenosis of the cervical anastomosis is a common postoperative complication after gastric tube reconstruction requiring endoscopic dilations. We hypothesized that radiation dose on the future anastomotic region (FAR) was related to the occurrence and severity of the anastomotic stenosis. We evaluated the incidence of stenosis and analyzed risk factors associated with severity of the stenosis.

Methods We performed a retrospective cohort study of all consecutive patients with esophageal or gastroesophageal junction carcinoma who underwent nCRT and esophageal resection with cervical anastomosis between 2010 and 2018. Severity of the stenosis was defined as number of dilations needed. Multivariable logistic regression analysis was used to identify patient and treatment related risk factors suspected to be associated with the severity of the anastomotic stenosis. The FAR was contoured in an average anatomy and deformed onto each individual CT-scan to extract the radiation dose on the FAR.

Results Among 192 patients, 180 patients (94%) developed a stenosis requiring at least one endoscopic dilation and 34 patients (18%) had radiologic and/or clinical anastomotic leakage. The median number of dilations in these 180 patients was 6 (IQR 2 to 11 dilations). In the multivariable analysis anastomotic leakage (p=0.02), T2/T3-stage (versus T4, p< 0.01), adenocarcinoma (versus squamous cell carcinoma, p=0.02) and midesophageal tumor location (versus distal/junctional, p< 0.05) were significantly associated with a higher number of dilations. The radiation dose on the FAR did not influence severity of stenosis.

Conclusions In our cohort almost all patients developed an anastomotic stenosis requiring endoscopic dilation. Amongst all, anastomotic leakage was significantly associated with the severity of the stenosis whereas radiation dose was not. Prevention of anastomotic leakage seems important to lower the burden of a stenotic cervical anastomosis.