Early thoracic surgery consultation and location of therapy impact time to esophagectomy

Neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy is the standard treatment for resectable, locally advanced esophageal cancer. The ideal timing between neoadjuvant therapy and esophagectomy is unclear. Delayed esophagectomy is associated with worse outcomes. We investigated which factors impacted time to esophagectomy in our patients.

We conducted a retrospective analysis of prospectively collected data of patients with pT0-3N0-2 esophageal cancers who underwent CROSS trimodality therapy from May 2016 to January 2020. Sociodemographic factors, comorbidities, and neoadjuvant factors (location of CRT, treatment toxicity, discontinuation of treatment) were compared between patients who underwent surgery within 60 days and those after 60 days.

In total, 197 patients were analyzed of whom 137 underwent esophagectomy within 60 days (early surgery, ES) and 60 were outside that window (delayed surgery, DS). More DS patients had a history of myocardial infarction (MI) or stroke (both 11.67% vs. 3.65%, P=0.05) and required CRT dose reduction (16.67% vs. 6.57%, P=0.04). Fewer DS patients received CRT at Dana-Farber Cancer Institute (DFCI) or a DFCI satellite site (33.33% vs. 58.4%, P=0.01) and saw our surgeons before CRT completion (68.33% vs. 89.78%, P=0.001). CRT at DFCI [odds ratio (OR) 2.63, P=0.01] or a satellite site (OR 3.07, P=0.01) and evaluation by a thoracic surgeon (OR 4.07, P=0.001) shortened time to esophagectomy. History of MI (OR 0.29, P=0.04), stroke (OR 0.29, P=0.04), and CRT dose reduction (OR 0.35, P=0.03) delayed time to esophagectomy.

Improving access to multispecialty cancer centers and increasing satellite sites may improve time to esophagectomy.