Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1235
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
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.
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.
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.
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).
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.
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.