Cargando…

Oesophageal adenocarcinoma: In the era of extended lymphadenectomy, is the value of neoadjuvant therapy being attenuated?

BACKGROUND: Neoadjuvant chemotherapy (NACT) and oesophagectomy is the standard of care for resectable oesophageal adenocarcinomas. Survival outcomes following resection have been improving over time while NACT remain largely unchanged. Indeed, a recent meta-analysis of randomized control trials did...

Descripción completa

Detalles Bibliográficos
Autores principales: Park, Jin-Soo, Van der Wall, Hans, Kennedy, Catherine, Falk, Gregory L
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554721/
https://www.ncbi.nlm.nih.gov/pubmed/34754391
http://dx.doi.org/10.4240/wjgs.v13.i10.1235
_version_ 1784591850349264896
author Park, Jin-Soo
Van der Wall, Hans
Kennedy, Catherine
Falk, Gregory L
author_facet Park, Jin-Soo
Van der Wall, Hans
Kennedy, Catherine
Falk, Gregory L
author_sort Park, Jin-Soo
collection PubMed
description BACKGROUND: Neoadjuvant chemotherapy (NACT) and oesophagectomy is the standard of care for resectable oesophageal adenocarcinomas. Survival outcomes following resection have been improving over time while NACT remain largely unchanged. Indeed, a recent meta-analysis of randomized control trials did not demonstrate a survival benefit in adding NACT, raising the possibility that improved surgical techniques may be reducing the perceived effectiveness of NACT. AIM: To compare the effect of addition of NACT to a standardized surgery and lymphadenectomy on overall and disease-free survival in patients undergoing curative oesophagectomy for oesophageal adenocarcinoma. METHODS: Patient data were analysed from a prospectively maintained surgical survival database. Demographic, surgical, and survival outcomes were compared between groups according to treatment and nodal count. RESULTS: The data of 243 consecutive patients were identified. 79 patients were given NACT and 162 had surgery only. The NACT group were younger, and there was less frequent stage I adenocarcinoma. Overall survival was similar between NACT and surgery only groups (5YS: 48.7% vs 42.5%; P = 0.113), as was disease-free survival (5YS: 40.6% vs 39.9%; P = 0.635). There were ≥ 30 nodes removed in 46 patients, and < 30 in 197 patients, but were otherwise similar. There was improved survival in patients with ≥ 30 nodes removed than those with < 30 nodes (5YS: 64.4% vs 40.7%; P = 0.015), and a better disease-free survival that neared significance (5YS: 54.9% vs 36.6%; P = 0.078). CONCLUSION: NACT did not appear to affect overall or disease-free survival. However, an overall survival benefit was observed in patients with ≥ 30 lymph nodes removed, and a benefit in disease-free survival which was not significant.
format Online
Article
Text
id pubmed-8554721
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher Baishideng Publishing Group Inc
record_format MEDLINE/PubMed
spelling pubmed-85547212021-11-08 Oesophageal adenocarcinoma: In the era of extended lymphadenectomy, is the value of neoadjuvant therapy being attenuated? Park, Jin-Soo Van der Wall, Hans Kennedy, Catherine Falk, Gregory L World J Gastrointest Surg Retrospective Study BACKGROUND: Neoadjuvant chemotherapy (NACT) and oesophagectomy is the standard of care for resectable oesophageal adenocarcinomas. Survival outcomes following resection have been improving over time while NACT remain largely unchanged. Indeed, a recent meta-analysis of randomized control trials did not demonstrate a survival benefit in adding NACT, raising the possibility that improved surgical techniques may be reducing the perceived effectiveness of NACT. AIM: To compare the effect of addition of NACT to a standardized surgery and lymphadenectomy on overall and disease-free survival in patients undergoing curative oesophagectomy for oesophageal adenocarcinoma. METHODS: Patient data were analysed from a prospectively maintained surgical survival database. Demographic, surgical, and survival outcomes were compared between groups according to treatment and nodal count. RESULTS: The data of 243 consecutive patients were identified. 79 patients were given NACT and 162 had surgery only. The NACT group were younger, and there was less frequent stage I adenocarcinoma. Overall survival was similar between NACT and surgery only groups (5YS: 48.7% vs 42.5%; P = 0.113), as was disease-free survival (5YS: 40.6% vs 39.9%; P = 0.635). There were ≥ 30 nodes removed in 46 patients, and < 30 in 197 patients, but were otherwise similar. There was improved survival in patients with ≥ 30 nodes removed than those with < 30 nodes (5YS: 64.4% vs 40.7%; P = 0.015), and a better disease-free survival that neared significance (5YS: 54.9% vs 36.6%; P = 0.078). CONCLUSION: NACT did not appear to affect overall or disease-free survival. However, an overall survival benefit was observed in patients with ≥ 30 lymph nodes removed, and a benefit in disease-free survival which was not significant. Baishideng Publishing Group Inc 2021-10-27 2021-10-27 /pmc/articles/PMC8554721/ /pubmed/34754391 http://dx.doi.org/10.4240/wjgs.v13.i10.1235 Text en ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Retrospective Study
Park, Jin-Soo
Van der Wall, Hans
Kennedy, Catherine
Falk, Gregory L
Oesophageal adenocarcinoma: In the era of extended lymphadenectomy, is the value of neoadjuvant therapy being attenuated?
title Oesophageal adenocarcinoma: In the era of extended lymphadenectomy, is the value of neoadjuvant therapy being attenuated?
title_full Oesophageal adenocarcinoma: In the era of extended lymphadenectomy, is the value of neoadjuvant therapy being attenuated?
title_fullStr Oesophageal adenocarcinoma: In the era of extended lymphadenectomy, is the value of neoadjuvant therapy being attenuated?
title_full_unstemmed Oesophageal adenocarcinoma: In the era of extended lymphadenectomy, is the value of neoadjuvant therapy being attenuated?
title_short Oesophageal adenocarcinoma: In the era of extended lymphadenectomy, is the value of neoadjuvant therapy being attenuated?
title_sort oesophageal adenocarcinoma: in the era of extended lymphadenectomy, is the value of neoadjuvant therapy being attenuated?
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554721/
https://www.ncbi.nlm.nih.gov/pubmed/34754391
http://dx.doi.org/10.4240/wjgs.v13.i10.1235
work_keys_str_mv AT parkjinsoo oesophagealadenocarcinomaintheeraofextendedlymphadenectomyisthevalueofneoadjuvanttherapybeingattenuated
AT vanderwallhans oesophagealadenocarcinomaintheeraofextendedlymphadenectomyisthevalueofneoadjuvanttherapybeingattenuated
AT kennedycatherine oesophagealadenocarcinomaintheeraofextendedlymphadenectomyisthevalueofneoadjuvanttherapybeingattenuated
AT falkgregoryl oesophagealadenocarcinomaintheeraofextendedlymphadenectomyisthevalueofneoadjuvanttherapybeingattenuated