Role of Neoadjuvant Chemotherapy in Resectable Esophageal Carcinoma: Impact on Surgical Outcomes.

Abstract

Background

Esophageal carcinoma is an aggressive malignancy associated with poor prognosis and substantial treatment-related morbidity. In patients with resectable disease, neoadjuvant chemotherapy has been used to improve tumor downstaging, increase the likelihood of complete resection, and treat micrometastatic disease before surgery. However, its impact on short-term surgical outcomes remains an important area of evaluation.

Objectives

To assess the role of neoadjuvant chemotherapy in patients with resectable esophageal carcinoma and to determine its impact on surgical outcomes, including postoperative complications, length of hospital stay, intensive care admission, and mortality.

Methodology

This retrospective comparative study was conducted at Department of Thoracic Surgery Unit, Lady Reading Hospital  Medical Teaching Institution, Peshawar from jan 2018 to jan 2019. A total of 65 patients with resectable esophageal carcinoma who underwent esophagectomy during the study period were included. Patients were divided into two groups: those who received neoadjuvant chemotherapy before surgery and those who underwent upfront surgery without neoadjuvant treatment. Demographic characteristics, tumor stage, operative duration, intraoperative blood loss, postoperative complications, hospital stay, ICU admission, and mortality were recorded using a structured data collection form. Data were analyzed using SPSS version 24. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. Statistical significance was set at p < 0.05.

Results

A total of 65 patients with resectable esophageal carcinoma were included in the study, with 33 patients in the neoadjuvant chemotherapy group and 32 patients in the upfront surgery group. The mean age of patients was 55.2 ± 10.8 years, and males constituted the majority of cases (66.2%). Patients who received neoadjuvant chemotherapy demonstrated a higher rate of complete resection than those who underwent upfront surgery (87.9% vs 75.0%). Postoperative complications were observed in 13 patients (39.4%) in the neoadjuvant chemotherapy group and 15 patients (46.9%) in the upfront surgery group. The most frequent complications were pulmonary complications, anastomotic leak, and wound infection. The mean hospital stay was slightly shorter in the neoadjuvant group (12.6 ± 4.1 days) compared with the surgery-alone group (13.9 ± 4.7 days). ICU admission was required in 5 patients (15.2%) in the neoadjuvant group and 6 patients (18.8%) in the surgery-alone group. Overall postoperative mortality was 5 patients (7.7%).

Conclusion

Neoadjuvant chemotherapy plays an important role in the management of resectable esophageal carcinoma and may improve surgical outcomes by increasing complete resection rates without significantly increasing postoperative morbidity. Careful perioperative assessment and multidisciplinary management remain essential to optimize outcomes in these patients.