Trimodality therapy for esophageal cancer: The role of surgical and radiation treatment parameters in the development of anastomotic complications

Abstract Background Here, we investigated the relationship between clinical parameters, including the site of surgical anastomosis and radiation dose to the anastomotic region, and anastomotic complications in esophageal cancer patients treated with trimodality therapy. Methods Between 2007 and 2016...

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Autores principales:	Salem Alfaifi, Robert Chu, Xuan Hui, Stephen Broderick, Craig Hooker, Malcolm Brock, Errol Bush, Russell Hales, Lori Anderson, Jeffrey Hoff, Cole Friedes, Sarah Han‐Oh, Todd Mcnutt, Jinny Ha, Stephen Yang, Richard Battafarano, Joy Feliciano, K. Ranh Voong
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	anastomotic leak anastomotic stricture esophageal cancer neoadjuvant radiation trimodality therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/ad95ac15aa6348a3acd323e6f178f3d1
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spelling	oai:doaj.org-article:ad95ac15aa6348a3acd323e6f178f3d12021-12-02T02:34:55ZTrimodality therapy for esophageal cancer: The role of surgical and radiation treatment parameters in the development of anastomotic complications1759-77141759-770610.1111/1759-7714.14130https://doaj.org/article/ad95ac15aa6348a3acd323e6f178f3d12021-12-01T00:00:00Zhttps://doi.org/10.1111/1759-7714.14130https://doaj.org/toc/1759-7706https://doaj.org/toc/1759-7714Abstract Background Here, we investigated the relationship between clinical parameters, including the site of surgical anastomosis and radiation dose to the anastomotic region, and anastomotic complications in esophageal cancer patients treated with trimodality therapy. Methods Between 2007 and 2016, esophageal cancer patients treated with trimodality therapy at a tertiary academic cancer center were identified. Patient, treatment, and outcome parameters were collected. Radiation dose to the gastric regions were extracted. Anastomotic complication was defined as leak and/or stricture. We used Fisher's exact and Wilcoxon rank‐sum tests to compare the association between clinical parameters and anastomotic complications. Results Of 89 patients identified, the median age was 63 years, 82% (n = 73) were male, and 82% had distal (n = 47) or gastroesophageal junction (n = 26) tumors. Median follow‐up was 25.8 months. Esophagectomies were performed with cervical (65%, n = 58) or thoracic anastomoses (35%, n = 31). Anastomotic complications developed in 60% (n = 53). Cervical anastomosis was associated with anastomotic complications (83%, n = 44/53, p < 0.01). Radiation to any gastric substructure was not associated with anastomotic complications (p > 0.05). In the subset of patients with distal/gastroesophageal junction tumors undergoing esophagectomy with cervical anastomosis where radiation was delivered to the future neoesophagus, 80% (n = 35/44) developed anastomotic complications. In this high‐risk subgroup, radiation was not associated with anastomotic complications (p > 0.05). Conclusions Our analysis did not demonstrate an association between radiation dose to gastric substructures and anastomotic complications. However, it showed an association between esophagectomy with cervical anastomosis and anastomotic complications. Patients with distal/gastroesophageal junction tumors who undergo esophagectomy with cervical anastomosis have higher rates of anastomotic complications unrelated to radiation to gastric substructures.Salem AlfaifiRobert ChuXuan HuiStephen BroderickCraig HookerMalcolm BrockErrol BushRussell HalesLori AndersonJeffrey HoffCole FriedesSarah Han‐OhTodd McnuttJinny HaStephen YangRichard BattafaranoJoy FelicianoK. Ranh VoongWileyarticleanastomotic leakanastomotic strictureesophageal cancerneoadjuvant radiationtrimodality therapyNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENThoracic Cancer, Vol 12, Iss 23, Pp 3121-3129 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	anastomotic leak anastomotic stricture esophageal cancer neoadjuvant radiation trimodality therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	anastomotic leak anastomotic stricture esophageal cancer neoadjuvant radiation trimodality therapy Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Salem Alfaifi Robert Chu Xuan Hui Stephen Broderick Craig Hooker Malcolm Brock Errol Bush Russell Hales Lori Anderson Jeffrey Hoff Cole Friedes Sarah Han‐Oh Todd Mcnutt Jinny Ha Stephen Yang Richard Battafarano Joy Feliciano K. Ranh Voong Trimodality therapy for esophageal cancer: The role of surgical and radiation treatment parameters in the development of anastomotic complications
description	Abstract Background Here, we investigated the relationship between clinical parameters, including the site of surgical anastomosis and radiation dose to the anastomotic region, and anastomotic complications in esophageal cancer patients treated with trimodality therapy. Methods Between 2007 and 2016, esophageal cancer patients treated with trimodality therapy at a tertiary academic cancer center were identified. Patient, treatment, and outcome parameters were collected. Radiation dose to the gastric regions were extracted. Anastomotic complication was defined as leak and/or stricture. We used Fisher's exact and Wilcoxon rank‐sum tests to compare the association between clinical parameters and anastomotic complications. Results Of 89 patients identified, the median age was 63 years, 82% (n = 73) were male, and 82% had distal (n = 47) or gastroesophageal junction (n = 26) tumors. Median follow‐up was 25.8 months. Esophagectomies were performed with cervical (65%, n = 58) or thoracic anastomoses (35%, n = 31). Anastomotic complications developed in 60% (n = 53). Cervical anastomosis was associated with anastomotic complications (83%, n = 44/53, p < 0.01). Radiation to any gastric substructure was not associated with anastomotic complications (p > 0.05). In the subset of patients with distal/gastroesophageal junction tumors undergoing esophagectomy with cervical anastomosis where radiation was delivered to the future neoesophagus, 80% (n = 35/44) developed anastomotic complications. In this high‐risk subgroup, radiation was not associated with anastomotic complications (p > 0.05). Conclusions Our analysis did not demonstrate an association between radiation dose to gastric substructures and anastomotic complications. However, it showed an association between esophagectomy with cervical anastomosis and anastomotic complications. Patients with distal/gastroesophageal junction tumors who undergo esophagectomy with cervical anastomosis have higher rates of anastomotic complications unrelated to radiation to gastric substructures.
format	article
author	Salem Alfaifi Robert Chu Xuan Hui Stephen Broderick Craig Hooker Malcolm Brock Errol Bush Russell Hales Lori Anderson Jeffrey Hoff Cole Friedes Sarah Han‐Oh Todd Mcnutt Jinny Ha Stephen Yang Richard Battafarano Joy Feliciano K. Ranh Voong
author_facet	Salem Alfaifi Robert Chu Xuan Hui Stephen Broderick Craig Hooker Malcolm Brock Errol Bush Russell Hales Lori Anderson Jeffrey Hoff Cole Friedes Sarah Han‐Oh Todd Mcnutt Jinny Ha Stephen Yang Richard Battafarano Joy Feliciano K. Ranh Voong
author_sort	Salem Alfaifi
title	Trimodality therapy for esophageal cancer: The role of surgical and radiation treatment parameters in the development of anastomotic complications
title_short	Trimodality therapy for esophageal cancer: The role of surgical and radiation treatment parameters in the development of anastomotic complications
title_full	Trimodality therapy for esophageal cancer: The role of surgical and radiation treatment parameters in the development of anastomotic complications
title_fullStr	Trimodality therapy for esophageal cancer: The role of surgical and radiation treatment parameters in the development of anastomotic complications
title_full_unstemmed	Trimodality therapy for esophageal cancer: The role of surgical and radiation treatment parameters in the development of anastomotic complications
title_sort	trimodality therapy for esophageal cancer: the role of surgical and radiation treatment parameters in the development of anastomotic complications
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/ad95ac15aa6348a3acd323e6f178f3d1
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Trimodality therapy for esophageal cancer: The role of surgical and radiation treatment parameters in the development of anastomotic complications

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