Impact of preoperative radiochemotherapy on postoperative course and survival in patients with locally advanced squamous cell oesophageal carcinoma

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Abstract
Background: The aim of this study was to determine the effect of neoadjuvant radiochemotherapy (RCT) on postoperative complications and survival after surgery for locally advanced oesophageal squamous cell carcinoma. Methods: Postoperative course and survival were compared in 144 patients who had neoadjuvant RCT and 80 control patients who had surgery alone for locally advanced oesophageal squamous cell carcinoma (radiological stage T3, N0 or N1, M0). Results: The two groups were comparable in terms of American Society of Anesthesiologists grade, age, sex, weight loss, tumour location, presence of lymph node metastasis and surgical approach. Postoperative mortality rates were 6·3 and 9 per cent (P = 0·481), with morbidity rates of 40·3 and 41 per cent (P = 0·887) in the RCT and control group respectively. Complete resection (R0) rates were 74·3 and 48 per cent respectively (P < 0·001). Significant downstaging was observed in the RCT group (P < 0·001), with 16·0 per cent of patients having a complete pathological response. Median survival was 29 versus 15 months, and the 5‐year survival rate 37 versus 17 per cent (P = 0·002) in RCT and control groups respectively. Conclusion: Neoadjuvant RCT significantly enhanced R0 resection and survival rates in patients with stage T3 oesophageal squamous cell carcinoma, with no increase in postoperative mortality and morbidity rates. Copyright © 2006 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.