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 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:
Corresponding author: Jin-Soo Park, BMed, MD, MS, Doctor, Upper GI Surgery, Concord Repatriation General Hospital, Hospital Road, Concord, Sydney 2137, NSW, Australia.
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
Research background

A meta-analysis of eleven randomized controlled trials did not demonstrate a survival benefit when comparing neoadjuvant chemotherapy (NACT) plus surgery vs surgery alone. There is uncertainty as to whether it is only neoadjuvant therapy that provides an improvement to overall survival, or other factors such as pre-operative staging, patient selection, or extent of resection and lymphadenectomy.

Research motivation

Techniques in oesophagectomy are improving, but the regimen for neoadjuvant therapies has largely remained static.

Research objectives

The authors aimed to assess 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.

Research methods

Survival data in a prospectively maintained surgical database were interrogated to review demographic, surgical, and survival outcomes. These were compared between groups according to treatment and nodal count.

Research results

The authors found that overall and disease-free survival were similar between patients that had undergone NACT preceding surgery and surgery only groups. There was improved survival in patients with ≥ 30 nodes removed than those with < 30 nodes and a better disease-free survival that neared significance.

Research conclusions

NACT did not appear to affect overall or disease-free survival in our cohort. Instead, an overall survival benefit was observed in patients who had ≥ 30 lymph nodes removed, and a benefit in disease-free survival which neared significance. Ideally, surgeons should aim to harvest more than 30 lymph nodes in the contemporary era.

Research perspectives

Conflicting results and mixed data in multiple studies suggests the need for further randomised controlled trials of neoadjuvant therapy and surgery with lymphadenectomy compared with surgery with lymphadenectomy alone.