Esophageal Cancer: Surgical Treatment of Esophageal Cancer – early outcomes and complications
The optimal interval between neoadjuvant chemoradiotherapy and esophagectomy for esophageal squamous cell carcinoma remains controversial. While delayed surgery may improve tumor regression and physiological recovery, concerns persist regarding operative difficulty and postoperative morbidity. This prospective study evaluates the impact of surgical timing on postoperative outcomes and pathological response following neoadjuvant chemoradiotherapy.
In this prospective study, patients with resectable esophageal squamous cell carcinoma underwent neoadjuvant chemoradiotherapy followed by minimally invasive esophagectomy. Patients were stratified based on surgery performed within 8 weeks or after 8 weeks of therapy completion. Postoperative complications were graded using the Clavien–Dindo classification. Pathological response was assessed using tumor regression grading. Outcomes were compared between groups.
Fifty patients were analyzed: 19 underwent surgery within 8 weeks and 31 after 8 weeks of neoadjuvant chemoradiotherapy. The delayed surgery group demonstrated a higher pathological complete response rate (48.4% vs 31.6%), though this difference was not statistically significant. Overall postoperative morbidity, including anastomotic leak and pulmonary complications, was comparable between groups. Importantly, postoperative mortality was significantly higher in the early surgery group (15.8% vs 0%; p=0.022). No increase in major complication rates was observed with delayed surgery.
Esophagectomy performed beyond 8 weeks after neoadjuvant chemoradiotherapy is not associated with increased postoperative morbidity and may significantly reduce postoperative mortality without compromising pathological response. Delayed surgery appears safe and potentially advantageous. Larger randomized studies are required to define the optimal surgical interval in esophageal squamous cell carcinoma.
C. Tandup, L. Singh, Manish Thakur et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Other
Esophageal cancer commonly presents with dysphagia and malnutrition. Esophagectomy following neoadjuvant chemoradiation is the standard treatment for locally advanced disease but is associated with significant postoperative morbidity. Immunonutrition may improve immune response and reduce postoperative complications.
This prospective comparative study included 36 patients with squamous cell carcinoma of the esophagus who underwent neoadjuvant chemoradiation followed by esophagectomy with conduit formation. Eighteen patients received preoperative immunonutrition supplementation for seven days in addition to standard diet, while outcomes were compared with 18 previously operated patients who received standard nutrition alone under similar perioperative conditions. Postoperative nutritional parameters, inflammatory markers, infective and non-infective complications, length of hospital stay, and mortality were analyzedto assess the impact of immunonutrition.
Patients receiving immunonutrition demonstrated a faster postoperative rise in serum albumin levels, though the overall trend was not statistically significant. A significant reduction in postoperative C-reactive protein levels was observed in the immunonutrition group. Pneumonia occurred in 22.2% of patients receiving immunonutrition compared to 61.1% in the standard nutrition group (p = 0.018). The incidence of anastomotic leak, conduit necrosis, and duration of hospital stay were lower in the immunonutrition group but did not reach statistical significance. No significant difference was observed in other complications or mortality.
Preoperative immunonutrition supplementation in patients undergoing esophagectomy for squamous cell carcinoma significantly reduced postoperative infective complications, particularly pneumonia, and improved early nutritional recovery. These findings support the routine use of immunonutrition in the perioperative management of esophageal cancer patients to enhance short-term outcomes.
Shivangi Sharma, C. Tandup, L. Reddy et al.· Diseases of the esophagus· 0 citations
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