| Summary: | <strong>Background: <br></strong>
Chemoradiotherapy (CRT) is a core component of multimodality treatment for locally advanced esophageal cancer. The timing of surgery following CRT may influence the probability of performing an oncological resection and the associated operative morbidity.
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Objective: <br></strong>
To determine the impact of delayed surgical intervention following CRT on survival from esophageal cancer.
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Methods: <br></strong>
This was an international, multi-center, cohort study, including patients from seventeen centers who received CRT followed by surgery between 2010-2020. In the main analysis patients were divided into four groups based upon the interval between chemoradiotherapy and surgery (0-50, 51-100, 101-200 and >200 d) to assess the impact upon 90-day mortality and 5-year overall survival (OS). Multivariable logistic and Cox regression provided hazard rations (HRs) with 95% confidence intervals (95%CI) adjusted for relevant patient, oncological and pathological confounding factors.
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Results: <br></strong>
2,867 patients who underwent esophagectomy after CRT were included. After adjustment for relevant confounders, prolonged interval following CRT was associated with an increased 90-day mortality compared to 0-50 days (reference): 51-100 days (HR=1.54, 95%CI 1.04-2.29), 101-200 days (HR=2.14, 95%CI 1.37-3.35) and >200 days (HR=3.06, 95%CI 1.64-5.69). Similarly, a poorer 5-year OS was also observed with prolonged interval following CRT compared to 0-50 days (reference): 101-200 days (HR=1.41, 95%CI 1.17-1.70) and >200 days (HR=1.64, 95%CI 1.24-2.17).
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Conclusion: <br></strong>
Prolonged interval following CRT before esophagectomy is associated with increased 90-day mortality and poorer long-term survival. Further investigation is needed to understand the mechanism that underpins these adverse outcomes observed with a prolonged interval to surgery.
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