• Annals of surgery · Nov 2020

    Randomized Controlled Trial Multicenter Study

    Surgical Morbidity and Mortality From the Multicenter Randomized Controlled NeoRes II Trial: Standard Versus Prolonged Time to Surgery After Neoadjuvant Chemoradiotherapy for Esophageal Cancer.

    • Klara Nilsson, Fredrik Klevebro, Ioannis Rouvelas, Mats Lindblad, Eva Szabo, Ingvar Halldestam, Ulrika Smedh, Bengt Wallner, Jan Johansson, Gjermund Johnsen, Eirik Kjus Aahlin, Hans-Olaf Johannessen, Geir Olav Hjortland, Isabel Bartella, Wolfgang Schröder, Christiane Bruns, and Magnus Nilsson.
    • Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.
    • Ann. Surg. 2020 Nov 1; 272 (5): 684-689.

    ObjectiveTo investigate if prolonged TTS after completed nCRT improves postoperative outcomes for esophageal and esophagogastric junction cancer.Summary Of Background DataTTS has traditionally been 4-6 weeks after completed nCRT. However, the optimal timing is not known.MethodsA multicenter clinical trial was performed with randomized allocation of TTS of 4-6 or 10-12 weeks. The primary endpoint of this sub-study was overall postoperative complications defined as Clavien-Dindo grade II-V. Secondary endpoints included complication severity according to Clavien-Dindo grade IIIb-V, postoperative 90-day mortality, and length of hospital stay. The study was registered in Clinicaltrials.gov (NCT02415101).ResultsIn total 249 patients were randomized. There were no significant differences between standard TTS and prolonged TTS with regard to overall incidence of complications Clavien-Dindo grade II-V (63.2% vs 72.6%, P = 0.134) or regarding Clavien-Dindo grade IIIb-V complications (31.6% vs 34.9%, P = 0.603). There were no statistically significant differences between standard and prolonged TTS regarding anastomotic leak (P = 0.596), conduit necrosis (P = 0.524), chyle leak (P = 0.427), pneumonia (P = 0.548), and respiratory failure (P = 0.723). In the standard TTS arm 5 patients (4.3%) died within 90 days of surgery, compared to 4 patients (3.8%) in the prolonged TTS arm (P = 1.0). Median length of hospital stay was 15 days in the standard TTS arm and 17 days in the prolonged TTS arm (P = 0.234).ConclusionThe timing of surgery after completed nCRT for carcinoma of the esophagus or esophagogastric junction, is not of major importance with regard to short-term postoperative outcomes.

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