Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2021; 13(10): 1235-1244
Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1235
Oesophageal adenocarcinoma: In the era of extended lymphadenectomy, is the value of neoadjuvant therapy being attenuated?
Jin-Soo Park, Hans Van der Wall, Catherine Kennedy, Gregory L Falk
Jin-Soo Park, Catherine Kennedy, Gregory L Falk, Upper GI Surgery, Concord Repatriation General Hospital, Sydney 2137, NSW, Australia
Jin-Soo Park, Department of Medicine, University of Notre Dame, Sydney 2007, NSW, Australia
Hans Van der Wall, CNI Molecular Imaging, Notre Dame University, Sydney 2114, NSW, Australia
Author contributions: Park JS contributed to manuscript drafting; Van der Wall H contributed to statistical analysis; Park JS and Kennedy C contributed to data collection, manuscript editing; Van der Wall H and Falk GL contributed to study conception, data collection, manuscript drafting, manuscript editing
Institutional review board statement: Data were extracted from a research database with current approval by the Sydney Local Health District Human Research Ethics Committee (reference: LNR/12CRGH/248).
Informed consent statement: Patients had given written informed consent for the study of data under the institutional ethics committee guidelines.
Conflict-of-interest statement: No conflicts of interest to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at jinsoo.park@health.nsw.gov.au. Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jin-Soo Park, BMed, MD, MS, Doctor, Upper GI Surgery, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney 2137, NSW, Australia. jinsoo.park@health.nsw.gov.au
Received: March 22, 2021
Peer-review started: March 22, 2021
First decision: August 15, 2021
Revised: August 23, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: October 27, 2021
Processing time: 218 Days and 7.5 Hours
Abstract
BACKGROUND

Neoadjuvant chemotherapy (NACT) and oesophagectomy is the standard of care for resectable oesophageal adenocarcinomas. Survival outcomes following resection have been improving over time while NACT remain largely unchanged. Indeed, a recent meta-analysis of randomized control trials did not demonstrate a survival benefit in adding NACT, raising the possibility that improved surgical techniques may be reducing the perceived effectiveness of NACT.

AIM

To compare the effect of addition of NACT to a standardized surgery and lymphadenectomy on overall and disease-free survival in patients undergoing curative oesophagectomy for oesophageal adenocarcinoma.

METHODS

Patient data were analysed from a prospectively maintained surgical survival database. Demographic, surgical, and survival outcomes were compared between groups according to treatment and nodal count.

RESULTS

The data of 243 consecutive patients were identified. 79 patients were given NACT and 162 had surgery only. The NACT group were younger, and there was less frequent stage I adenocarcinoma. Overall survival was similar between NACT and surgery only groups (5YS: 48.7% vs 42.5%; P = 0.113), as was disease-free survival (5YS: 40.6% vs 39.9%; P = 0.635). There were ≥ 30 nodes removed in 46 patients, and < 30 in 197 patients, but were otherwise similar. There was improved survival in patients with ≥ 30 nodes removed than those with < 30 nodes (5YS: 64.4% vs 40.7%; P = 0.015), and a better disease-free survival that neared significance (5YS: 54.9% vs 36.6%; P = 0.078).

CONCLUSION

NACT did not appear to affect overall or disease-free survival. However, an overall survival benefit was observed in patients with ≥ 30 lymph nodes removed, and a benefit in disease-free survival which was not significant.

Keywords: Oesophagectomy; Oesophageal adenocarcinoma; Neoadjuvant chemotherapy; Lymphadenectomy; Survival outcome; Surgical technique

Core Tip: This study aimed to compare the effect of neoadjuvant chemotherapy to a standardized surgery and lymphadenectomy on survival outcomes in curative oesophagectomy for cancer. Overall and disease-free survival were similar between neoadjuvant chemotherapy (NACT) and surgery only groups. There was improved survival in patients with ≥ 30 nodes harvested compared to those with < 30 nodes. The possibility that improved lymphadenectomy techniques, as opposed to NACT, improves survival outcomes in curative resection of oesophageal adenocarcinoma warrants further investigation.