Journal of Universal Surgery

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The Implications of the Introduction of Neoadjuvant Chemoradiotherapy for Oesophageal Cancer in a Low Volume Centre

Hazel Serrao-Brown and James Fergusson

Background: Oesophagectomy is the standard treatment for oesophageal cancer in medically fit patients, but is associated with significant morbidity and mortality. Neoadjuvant chemoradiotherapy has been included in the management of this disease with the aim to improve prognosis, and has been shown to improve survival without an associated increase in operative complications. This study included patients who underwent oesophagectomy at the Canberra Hospital, to determine if neoadjuvant therapy was associated with an increase in perioperative morbidity and mortality.

Methods: Patients who underwent oesophagectomy at Canberra Hospital between January 2001 and December 2012 were reviewed retrospectively. Statistical analysis was performed using Chi-Squared tests, time to disease recurrence was estimated using Kaplan-Meier methods.

Results: Of 98 patients (73 men, 25 women; median age 63 years) who underwent oesophagectomy, 39 (40%) received neoadjuvant therapy. Perioperative complications of grades III (67%) and IV (100%), occurred in the surgery alone group. Perioperative mortality rate was 3.8%, with all deaths occurring in the surgery alone group (P=0.05). Complete resection was possible in 87 patients (89%), 100% in the neoadjuvant therapy group, 82% in the surgery alone group (P=0.10). Median disease free survival was 49.2 months (CI 25.2, 73.2), with no significant difference between patient groups (P=0.53).

Neoadjuvant therapy was associated with lower perioperative morbidity, with no statistically significant increase in perioperative mortality. It was also associated with improved rates of complete resection; however this did not appear to have translated into improved disease free survival.