558. SURVIVAL IMPACT OF CLINICAL AND NONCLINICAL REASONS FOR DELAY TO ESOPHAGECTOMY AFTER NEOADJUVANT CROSS THERAPY. (24th September 2022)

• Record Type: Journal Article
• Authors: Dave, Yatee; Kapcio, Kevin; Linville, Wendy; Strawderman, Myla; Peyre, Christian; Jones, Carolyn; Lada, Michal
• Is Part Of: Diseases of the esophagus. Volume 35(2022)Supplement 2
• Publication Date: 2022-09-24
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doac051.558
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: The optimal time interval between completion of standard-of-care neoadjuvant CROSS chemoradiation and esophagectomy (CRT-S) in patients with esophageal cancer remains controversial. Precise reasons for prolongment of this interval are not well described, although studies have associated a prolonged CRT-S with variable survival outcomes. We aimed to evaluate whether specific reasons for delay to esophagectomy beyond the recommended period of 8 weeks post-chemoradiation are associated with differences in overall survival (OS). A prospectively maintained database was reviewed for patients with esophageal cancer at a single academic institution who completed neoadjuvant CROSS therapy and underwent subsequent esophagectomy from 2012 to 2019. Patients were grouped by time interval of CRT-S into a no-delay group (≤56 days) and delay group (>56 days). The delay group was then further stratified by clinical and nonclinical reasons for delay. Demographics, comorbidities and complications were compared. A multivariable Cox regression model was used to evaluate the impact of variables on OS from time of surgery. Survival outcomes were described using standard Kaplan-Meier curves. Of 96 patients, 48 (50.5%) had delays, with 62.5% (n=30) being for nonclinical reasons. Post-operative complications were similar between the no-delay and delay subgroups, except that the clinical delay group had more unplanned intensive care unit admissions (p=0.032). The median CRT-S for the no-delay, overall delay, clinical delay, and nonclinical delay groups were 47, 71, 79, and 68 days, respectively. On multivariable analysis, nonclinical delay, male gender, pathologic complete response, and tumor location were independent predictors of improved survival. A nonclinical delay was associated with improved OS (p=0.010) while clinical delay was not significantly different (p=0.968) from the no-delay group. Patients with delay to esophagectomy greater than 8 weeks for nonclinical reasons after completion of chemoradiation had improved survival compared to patients undergoing esophagectomy within 8 weeks or who had delayed surgery for clinical reasons. Delay for nonclinical reasons was not associated with increased rates of postoperative complications. Future studies regarding the optimal time interval between the completion of neoadjuvant chemoradiation and esophagectomy need to consider the specific reasons for delay to surgery.