Neoadjuvant Chemo (radio) therapy and anastomotic leakage risk in patients with esophageal squamous cell carcinoma

To investigate the different impacts of neoadjuvant chemotherapy (NCT) and neoadjuvant chemoradiotherapy (NCRT) on anastomotic leakage after esophageal cancer resection.

The data of three clinical studies (222 patients) launched were retrospectively collected, including 113 patients in the NCRT group and 109 patients in the NCT group. The NCT group received platinum-based doublet chemotherapy once every 3-4 weeks, whereas the NCRT group received platinum-based doublet chemotherapy weekly (taxane-containing regimen) or once every 3-4 weeks (5-Fu-containing regimen) concurrently with thoracic radiotherapy. After neoadjuvant therapy, all patients underwent Ivor-Lewis or McKeown esophagectomy. The study compared the pathologic complete remission (pCR) rate, 30-day post-operative mortality rate, incidence of anastomotic leakage, post-operative complications, and survival rates between the two groups.

The pCR rate, 30-day post-operative mortality rate, and the incidence of anastomotic leakage were 39.8% versus 5.5% (p < 0.001), 2.7% versus 0% (p = 0.043), and 28.3% versus 5.5% (p < 0.001) in the NCRT group and NCT group, respectively. Multivariate analysis showed that only NCRT significantly increased the incidence of anastomotic leakage (odds ratio 7.28, 95% confidence interval 2.44-21.78, p < 0.001).

The results show that NCRT can improve the pathological response rate but will increase the incidence of anastomotic leakage. Radiation dose-volume parameters were not associated with anastomotic leakage risk.