Early thoracic surgery consultation and location of therapy impact time to esophagectomy.

Autor:	Deeb AL; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Dezube AR; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Lozano A; Boston University School of Medicine, Boston, MA, USA., Singh A; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., De Leon LE; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Kucukak S; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Jaklitsch MT; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA., Wee JO; Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Jazyk:	angličtina
Zdroj:	Journal of thoracic disease [J Thorac Dis] 2024 Sep 30; Vol. 16 (9), pp. 5615-5623. Date of Electronic Publication: 2024 Sep 21.
DOI:	10.21037/jtd-24-316
Abstrakt:	Background: Neoadjuvant chemoradiation therapy (nCRT) followed by esophagectomy is the standard treatment for resectable, locally advanced esophageal cancer. The ideal timing between neoadjuvant therapy and esophagectomy is unclear. Delayed esophagectomy is associated with worse outcomes. We investigated which factors impacted time to esophagectomy in our patients. Methods: We conducted a retrospective analysis of prospectively collected data of patients with pT0-3N0-2 esophageal cancers who underwent CROSS trimodality therapy from May 2016 to January 2020. Sociodemographic factors, comorbidities, and neoadjuvant factors (location of CRT, treatment toxicity, discontinuation of treatment) were compared between patients who underwent surgery within 60 days and those after 60 days. Results: In total, 197 patients were analyzed of whom 137 underwent esophagectomy within 60 days (early surgery, ES) and 60 were outside that window (delayed surgery, DS). More DS patients had a history of myocardial infarction (MI) or stroke (both 11.67% vs. 3.65%, P=0.05) and required CRT dose reduction (16.67% vs. 6.57%, P=0.04). Fewer DS patients received CRT at Dana-Farber Cancer Institute (DFCI) or a DFCI satellite site (33.33% vs. 58.4%, P=0.01) and saw our surgeons before CRT completion (68.33% vs. 89.78%, P=0.001). CRT at DFCI [odds ratio (OR) 2.63, P=0.01] or a satellite site (OR 3.07, P=0.01) and evaluation by a thoracic surgeon (OR 4.07, P=0.001) shortened time to esophagectomy. History of MI (OR 0.29, P=0.04), stroke (OR 0.29, P=0.04), and CRT dose reduction (OR 0.35, P=0.03) delayed time to esophagectomy. Conclusions: Improving access to multispecialty cancer centers and increasing satellite sites may improve time to esophagectomy. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-316/coif). A.L.D. and A.S. were supported by the John D. Mitchell Thoracic Oncology Fellowship. The other authors have no conflicts of interest to declare. (2024 AME Publishing Company. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu