Effect of Neoadjuvant Therapy on Endoluminal Vacuum-Assisted Closure Therapy (EVAC) for Anastomotic Leakage After Oesophagectomy.

Autor: Fahrenkrog, Catharina, Miftode, Sorin, Al-Mawsheki, Ahmed, Alfarawan, Fadl, Wilters, Stella, Bockhorn, Maximilian, El-Sourani, Nader
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Zdroj: Cancers; Nov2024, Vol. 16 Issue 21, p3597, 13p
Abstrakt: Simple Summary: Anastomotic leakage (AL) has a reported incidence of up to 53% and contributes to a high morbidity and mortality after oesophagectomy. Because of its high success rates, endoluminal vacuum-assisted closure therapy (EVAC) is nowadays the standard treatment for AL. However, its effectiveness depends upon different factors. As most patients receive trimodal therapy (neoadjuvant therapy, followed by surgery and adjuvant therapy) due to their preoperative cancer staging, the question arises as to whether neoadjuvant therapy impacts the success rate of EVAC. Therefore, our aim was to identify any adverse effects of a neoadjuvant therapy on EVAC compared to no prior treatment, in order to improve patient care and treatment algorithms. We found no significant influence of neoadjuvant therapy on EVAC. Furthermore, EVAC proved to be an effective and secure treatment option, leading to no changes in the management of AL for now. Background: Anastomotic leakage (AL) is a dreaded complication after oesophagectomy. Endoluminal vacuum-assisted closure therapy (EVAC) has been increasingly used as a first-line treatment for AL. We aimed to identify any potential adverse effects of a neoadjuvant therapy (chemotherapy (CT) or radiochemotherapy (RCT)) on EVAC. Methods: We performed a retrospective cohort study at our tertiary centre between 2013 and 2024. All patients who underwent EVAC for AL after oesophagectomy were included in this study. Parameters such as success rate, length of therapy, number of sponges needed, changes in treatment, and survival were analysed. Results: A total of 29 patients were included, 19 of whom received CT/RCT and 10 of whom received no neoadjuvant treatment (NT). There was no significant difference in patient survival (30-day survival rate CT/RCT n = 1 (5.3%) vs. NT n = 1 (10%), p = 0.632), success rate (CT/RCT n = 15 (78.9%) vs. NT n = 9 (90%), p = 0.454), and length of therapy (CT/RCT vs. NT 24.11 vs. 23.8, p = 0.681), the number of sponges required (CT/RCT vs. NT 6.26 vs. 6.6, p = 0.835), and the need for changing treatment (CT/RCT n = 5 (26.3%) vs. NT n = 1 (10%), p = 0.303). Conclusions: NT did not affect the success rate or length of therapy. Thus, we found no significant influence of CT/RCT on EVAC for AL after oesophagectomy. [ABSTRACT FROM AUTHOR]
Databáze: Complementary Index
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