P1.194. Timing of Esophagectomy After Neoadjuvant Chemoradiotherapy in Esophageal Squamous Cell Carcinoma

Abstract

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.