Korean J Thorac Cardiovasc Surg 2019; 52(1): 1-8  https://doi.org/10.5090/kjtcs.2019.52.1.1
Timing of Esophagectomy after Neoadjuvant Chemoradiation Therapy Affects the Incidence of Anastomotic Leaks
Simon Roh, M.D.1, Mark D. Iannettoni, M.D.2, John Keech, M.D.3, Evgeny V. Arshava, M.D.3, Anthony Swatek, M.D.3, Miriam B. Zimmerman, Ph.D.4, Ronald J. Weigel, M.D., Ph.D.3, Kalpaj R. Parekh, M.B.B.S.3
1Division of Interventional Radiology, New York Presbyterian Hospital–Weill Cornell Medical Center, 2Department of Cardiovasular Sciences, East Carolina University, 3Department of Surgery, University of Iowa Hospitals and Clinics, 4Department of Biostatistics, University of Iowa College of Public Health
Corresponding author: Kalpaj R. Parekh, Department of Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA
(Tel) 1-319-353-6758 (Fax) 1-319-356-3891 (E-mail) kalpaj-parekh@uiowa.edu
Received: May 24, 2018; Revised: November 13, 2018; Accepted: November 14, 2018.; Published online: February 5, 2019.
© The Korean Journal of Thoracic and Cardiovascular Surgery. All rights reserved.

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Abstract
Background: Neoadjuvant chemoradiation therapy (nCRT) has become the standard of care for esophageal cancer patients prior to esophagectomy. However, the optimal timing for surgery after completion of nCRT remains unclear. Methods: A retrospective review was performed of patients who underwent esophagectomy with cervical anastomosis for esophageal cancer at a single institution between January 2000 and June 2015. Patients were categorized into 3 cohorts: those who did not receive nCRT prior to esophagectomy (no nCRT), those who underwent esophagectomy within 35 days after nCRT (≤35d), and those who underwent esophagectomy more than 35 days after nCRT (>35d). Results: A total of 366 esophagectomies were performed during the study period, and 348 patients met the inclusion criteria. Anastomotic leaks occurred in 11.8% of all patients included in the study (41 of 348). Within each cohort, anastomotic leaks were detected in 14.7% of patients (17 of 116) in the no nCRT cohort, 7.3% (13 of 177) in the ≤35d cohort, and 20.0% (11 of 55) in the >35d cohort (p=0.020). Significant differences in the occurrence of anastomotic leaks were observed between the no nCRT and ≤35d cohorts (p=0.044), and between the ≤35d and >35d cohorts (p=0.007). Conclusion: Esophagectomy with cervical anastomosis within 35 days of nCRT resulted in a lower percentage of anastomotic leaks.
Keywords: Esophageal neoplasms, Esophagectomy, Anastomotic leak, Chemoradiotherapy, Neoadjuvant therapy


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