The Influence of Neoadjuvant Therapy on Morbidity and Mortality after Surgery for Thoracic Esophageal Cancer

Kenji Tsutsumi, Harushi Udagawa, Yoshihiro Kinoshita, Masaki Ueno, Toyohide Nakamura, Toshihito Sawada, Gorou Watanabe, Hiroshi Akiyama, Masahiko Tsurumaru^* and Yoshiaki Kajiyama

Department of Surgery, Toranomon Hospital

^*First Department of Surgery, Juntendo University School of Medicine

We investigated 636 patients who underwent esophagectomy for thoracic esophageal cancer between 1984 and 1997 to clarify the influence of neoadjuvant therapy (NT) on postoperative morbidity and mortality. Among these 636 patients, neoadjuvant therapy was performed in 113. Of the 113 patients, 52 patients underwent preoperative chemotherapy (CT), 53 underwent radiotherapy (RT), 8 chemoradiotherapy (CRT). The remaining 523 patients were treated with surgery alone (SA). Differences in serum albumin and body mass index before and after these treatments were not statistically significant, whereas differences in peripheral white blood cell and lymphocyte counts between SA and after RT or between SA and after CRT were statistically significant. Furthemore, there were statistical significances in the changes of peripheral white blood cell and lymphocyte counts before and after treatment in the RT and the CRT. The incidence of postoperative pneumonia and colitis in CRT were 37.5% and 37.5% respectively, which were significantly higher than the incidence in SA. There were no statistically significant differences in morbidity and mortality rates at 30 days after operation between the groups. The incidence of postoperative pneumonia between patients with and without CRT exhibited a statistically significant difference by univariate analysis. Additionally, logistic regression analysis revealed the CRT was one of the most important risk factors for postoperative pneumonia. Therefore, after neoadjuvant chemoradiotherapy patients should be considered as in an immunosupressive state prior to surgery which will require careful and special postoperative management.

Key words
esophageal cancer, neoadjuvant therapy, chemoradiation therapy, postoperative complication, mortality

Reprint requests
Kenji Tsutsumi Department of Surgery, Toranomon Hospital2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470 JAPAN

Accepted
November 30, 1999

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