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Conference Paper: What is the appropriate timing for surgery after neoadjuvant chemoradiation for esophageal cancer

TitleWhat is the appropriate timing for surgery after neoadjuvant chemoradiation for esophageal cancer
Authors
KeywordsMedical sciences
Surgery
Issue Date2011
PublisherSpringer New York LLC. The Journal's web site is located at http://link.springer.de/link/service/journals/00268/
Citation
The International Surgical Week (ISW2011), Yokohama, Japan, 28 August-1 September 2011. In World Journal of Surgery, 2011, v. 35 suppl. 1, p. S172, abstract no. 0450 How to Cite?
AbstractINTRODUCTION: The optimal interval between neoadjuvant chemoradiation (CRT) and surgery has not been elucidated for squamous esophageal cancer (ESC). The aim of this study is to evaluate the impact of this time interval on postoperative and long-term outcomes. MATERIAL AND METHODS: A total of 107 patients with intrathoracic ESC treated with neoadjuvant CRT between 2002 and 2009 were analyzed from a prospectively collected database. Patients were divided into three groups based on the interval between completion of CRT and surgery: group A: <40 days (n = 16); B: 41–80 days (n = 60); and C: >80 days (n = 31). Survival was also compared by dividing these patients into two groups using the median interval (64 days) as the cutoff point: group A* (n = 54) and B* (n = 53). Intraoperative parameters, postoperative outcomes, pathological data and long-term survival were investigated. RESULTS: The three groups were comparable in patient and tumor characteristics, intraoperative parameters, postoperative morbidity and mortality. Pathological analysis showed that the median number of lymph nodes harvested was comparable. All three groups had significant rate of downstaging [A: n = 8 (50%), B: n = 43 (71.7%), C: n = 21 (67.7%)]. For group A, the rate of R0 resection was significantly lower than the other two groups [A: n = 9 (56.3%), B: n = 54 (90%), C: n = 23 (74.2%), P = 0.006]. The pathological complete response (pCR) rates were comparable [A: n = 5(31.2%), B: n = 21(35%), C: n = 6(19.4%), P = 0.301]. Overall 3-year survival were 73.4, 66.7, and 53.5% respectively, P = 0.23. After R0 resection, group A had longer 3-year survival (100%) compared to group B (73%) and C (64.4%), (log-rank test: A vs. B, P = 0.04; A vs. C, P = 0.015; B vs. C, P = 0.315). Using the median interval (64 days) as the dividing point, the overall 3-year survivals of group A* and B* were 71.1 and 56.5%, respectively, P = 0.081. If R0 was achieved, the 3-year survival of group A* and B* were 83.4 and 64.3%, P = 0.023. With R0 resection, though statistically not significant, there was no tumor recurrence detected in group A, whereas 8 (14.8%) and 5 (21.7%) patients had tumor recurrence in group B and C during follow up, P = 0.302. CONCLUSION: Interval between CRT and surgery did not affect postoperative morbidity and mortality. Although early surgery seemed to result in less R0 resection, overall survival was not compromised. In those with R0 resection, better survival was attained. Delayed surgery may compromise long-term survival.
DescriptionThis journal supplement is proceedings of ISW2011
Theme of Conference: Exploring the Future of Surgery
Session 22.01 - ISDS Free Papers, Esophagus 1: Malignant
Persistent Identifierhttp://hdl.handle.net/10722/140589
ISSN
2015 Impact Factor: 2.523
2015 SCImago Journal Rankings: 1.375

 

DC FieldValueLanguage
dc.contributor.authorTong, Den_US
dc.contributor.authorLaw, Sen_US
dc.contributor.authorKwong, DLWen_US
dc.contributor.authorChan, SYen_US
dc.contributor.authorWong, KHen_US
dc.date.accessioned2011-09-23T06:15:28Z-
dc.date.available2011-09-23T06:15:28Z-
dc.date.issued2011en_US
dc.identifier.citationThe International Surgical Week (ISW2011), Yokohama, Japan, 28 August-1 September 2011. In World Journal of Surgery, 2011, v. 35 suppl. 1, p. S172, abstract no. 0450en_US
dc.identifier.issn0364-2313-
dc.identifier.urihttp://hdl.handle.net/10722/140589-
dc.descriptionThis journal supplement is proceedings of ISW2011-
dc.descriptionTheme of Conference: Exploring the Future of Surgery-
dc.descriptionSession 22.01 - ISDS Free Papers, Esophagus 1: Malignant-
dc.description.abstractINTRODUCTION: The optimal interval between neoadjuvant chemoradiation (CRT) and surgery has not been elucidated for squamous esophageal cancer (ESC). The aim of this study is to evaluate the impact of this time interval on postoperative and long-term outcomes. MATERIAL AND METHODS: A total of 107 patients with intrathoracic ESC treated with neoadjuvant CRT between 2002 and 2009 were analyzed from a prospectively collected database. Patients were divided into three groups based on the interval between completion of CRT and surgery: group A: <40 days (n = 16); B: 41–80 days (n = 60); and C: >80 days (n = 31). Survival was also compared by dividing these patients into two groups using the median interval (64 days) as the cutoff point: group A* (n = 54) and B* (n = 53). Intraoperative parameters, postoperative outcomes, pathological data and long-term survival were investigated. RESULTS: The three groups were comparable in patient and tumor characteristics, intraoperative parameters, postoperative morbidity and mortality. Pathological analysis showed that the median number of lymph nodes harvested was comparable. All three groups had significant rate of downstaging [A: n = 8 (50%), B: n = 43 (71.7%), C: n = 21 (67.7%)]. For group A, the rate of R0 resection was significantly lower than the other two groups [A: n = 9 (56.3%), B: n = 54 (90%), C: n = 23 (74.2%), P = 0.006]. The pathological complete response (pCR) rates were comparable [A: n = 5(31.2%), B: n = 21(35%), C: n = 6(19.4%), P = 0.301]. Overall 3-year survival were 73.4, 66.7, and 53.5% respectively, P = 0.23. After R0 resection, group A had longer 3-year survival (100%) compared to group B (73%) and C (64.4%), (log-rank test: A vs. B, P = 0.04; A vs. C, P = 0.015; B vs. C, P = 0.315). Using the median interval (64 days) as the dividing point, the overall 3-year survivals of group A* and B* were 71.1 and 56.5%, respectively, P = 0.081. If R0 was achieved, the 3-year survival of group A* and B* were 83.4 and 64.3%, P = 0.023. With R0 resection, though statistically not significant, there was no tumor recurrence detected in group A, whereas 8 (14.8%) and 5 (21.7%) patients had tumor recurrence in group B and C during follow up, P = 0.302. CONCLUSION: Interval between CRT and surgery did not affect postoperative morbidity and mortality. Although early surgery seemed to result in less R0 resection, overall survival was not compromised. In those with R0 resection, better survival was attained. Delayed surgery may compromise long-term survival.-
dc.languageengen_US
dc.publisherSpringer New York LLC. The Journal's web site is located at http://link.springer.de/link/service/journals/00268/-
dc.relation.ispartofWorld Journal of Surgeryen_US
dc.rightsThe original publication is available at www.springerlink.com-
dc.subjectMedical sciences-
dc.subjectSurgery-
dc.titleWhat is the appropriate timing for surgery after neoadjuvant chemoradiation for esophageal canceren_US
dc.typeConference_Paperen_US
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0364-2313&volume=35&issue=Suppl. 1&spage=S172, Abstract ID: 0450&epage=&date=2011&atitle=What+is+the+appropriate+timing+for+surgery+after+neoadjuvant+chemoradiation+for+esophageal+cancer-
dc.identifier.emailTong, D: esodtong@hku.hken_US
dc.identifier.emailLaw, S: slaw@hku.hken_US
dc.identifier.emailKwong, DLW: dlwkwong@hkucc.hku.hken_US
dc.identifier.emailChan, SY: fsychan@hku.hken_US
dc.identifier.authorityLaw, S=rp00437en_US
dc.identifier.authorityKwong, DLW=rp00414en_US
dc.identifier.hkuros196103en_US
dc.identifier.hkuros196108-
dc.identifier.volume35-
dc.identifier.issuesuppl. 1-
dc.identifier.spageS172-
dc.identifier.epageS172-
dc.description.otherThe International Surgical Week (ISW2011), Yokohama, Japan, 28 August-1 September 2011. In World Journal of Surgery, 2011, v. 35 suppl. 1, p. S172, abstract no. 0450-

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