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| |  Neoadjuvant Therapy Increases Mortality Risk in Patients Undergoing Oesophageal Resection for Malignant Disease: Presented at ACS By Jill Stein CHICAGO -- October 14, 2009 -- Neoadjuvant therapy appears to increase mortality in patients undergoing oesophageal resection for malignant disease, according to data presented here October 14 at the American College of Surgeons (ACS) 95th Annual Clinical Congress. Sumeet Mittal, MD, Creighton University Medical Center, Omaha, Nebraska, and colleagues evaluated morbidity and mortality in a series of patients with or without neoadjuvant therapy for oesophageal resection for malignant disease. The incidence of oesophageal cancer has increased by 700% in the United States over the last 25 years, Dr. Mittal pointed out at a poster presentation. Oesophageal cancer has a dismal prognosis with an estimated 10% of patients remaining alive at 5 years. While oesophageal resection has historically been the sole treatment that has been consistently shown to improve survival, it nonetheless carries a morbidity and mortality rate of 70% and 14%, respectively. In addition, for patients treated with surgery alone, the median survival has been reported to be 11 months, with a 3-year survival of 25%. Poor prognosis often results from the advanced nature of the disease at presentation. The present analysis included 99 patients undergoing oesophageal resection for adenocarcinoma or squamous cell carcinoma. Of these, 64 patients received neoadjuvant chemotherapy, radiation, or both. The other 35 patients had surgery without neoadjuvant therapy. Most patients in both groups had gastric pull-up. All other patients had either Roux-en-Y esophagojejunostomy or a Merendino jejunal interposition. The 2 groups were similar with respect to age and comorbidities. Overall, 4 of 99 patients died. All deaths were in the neoadjuvant therapy group. The causes of death were acute respiratory distress syndrome in 1 patient, pneumonia and renal failure in 1 patient, pulmonary embolism in 1 patient, and intrathoracic haemorrhage in 1 patient. The 2 groups did not differ with respect to the duration of surgery, estimated blood loss, days spent in the intensive care unit, chyle leak, pulmonary complications, and wound dehiscence. “Overall, the results show a trend towards increased mortality in patients receiving neoadjuvant treatment for malignant oesophageal disease,” Dr. Mittal said. [Presentation title: Neoadjuvant Treatment Increases Mortality After Esophagectomy a Single Center Experience. Abstract SE169-T]
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