Oesophageal adenocarcinoma:In the era of extended lymphadenectomy,is the value of neoadjuvant therapy being attenuated?  

作　　者：Jin-Soo Park Hans Van der Wall Catherine Kennedy Gregory L Falk 

机构地区：[1]Upper GI Surgery,Concord Repatriation General Hospital,Sydney 2137,NSW,Australia [2]Department of Medicine,University of Notre Dame,Sydney 2007,NSW,Australia [3]CNI Molecular Imaging,Notre Dame University,Sydney 2114,NSW,Australia

出　　处：《World Journal of Gastrointestinal Surgery》2021年第10期1235-1244,共10页世界胃肠外科杂志（英文版）（电子版）

摘　　要：BACKGROUND Neoadjuvant chemotherapy(NACT)and oesophagectomy is the standard of care for resectable oesophageal adenocarcinomas.Survival outcomes following resection have been improving over time while NACT remain largely unchanged.Indeed,a recent meta-analysis of randomized control trials did not demonstrate a survival benefit in adding NACT,raising the possibility that improved surgical techniques may be reducing the perceived effectiveness of NACT.AIM To compare the effect of addition of NACT to a standardized surgery and lymphadenectomy on overall and disease-free survival in patients undergoing curative oesophagectomy for oesophageal adenocarcinoma.METHODS Patient data were analysed from a prospectively maintained surgical survival database.Demographic,surgical,and survival outcomes were compared between groups according to treatment and nodal count.RESULTS The data of 243 consecutive patients were identified.79 patients were given NACT and 162 had surgery only.The NACT group were younger,and there was less frequent stage I adenocarcinoma.Overall survival was similar between NACT and surgery only groups(5YS:48.7%vs 42.5%;P=0.113),as was diseasefree survival(5YS:40.6%vs 39.9%;P=0.635).There were≥30 nodes removed in 46 patients,and<30 in 197 patients,but were otherwise similar.There was improved survival in patients with≥30 nodes removed than those with<30 nodes(5YS:64.4%vs 40.7%;P=0.015),and a better disease-free survival that neared significance(5YS:54.9%vs 36.6%;P=0.078).CONCLUSION NACT did not appear to affect overall or disease-free survival.However,an overall survival benefit was observed in patients with≥30 lymph nodes removed,and a benefit in disease-free survival which was not significant.

关 键 词：OESOPHAGECTOMY Oesophageal adenocarcinoma Neoadjuvant chemotherapy LYMPHADENECTOMY Survival outcome Surgical technique 

分 类 号：R735.1[医药卫生—肿瘤]