Neoadjuvant Chemo (radio) therapy and anastomotic leakage risk in patients with esophageal squamous cell carcinoma

Objective: To investigate the different impacts of neoadjuvant chemotherapy (NCT) and neoadjuvant chemoradiotherapy (NCRT) on anastomotic leakage after esophageal cancer resection.Methods: The data of three clinical studies (222 patients) launched were retrospectively collected, including 113 patients in the NCRT group and 109 patients in the NCT group.The NCT group received platinum-based doublet chemotherapy once every 3-4 weeks, whereas the NCRT group received platinum-based doublet chemotherapy weekly (taxane-containing regimen) or once every 3-4 weeks (5-Fu-containing regimen) concurrently with thoracic radiotherapy.After neoadjuvant therapy, all patients underwent Ivor-Lewis or McKeown esophagectomy.The study compared the pathologic complete remission (pCR) rate, 30-day post-operative mortality rate, incidence of anastomotic leakage, post-operative complications, and survival rates between the two groups.Results: The pCR rate, 30-day postoperative mortality rate, and the incidence of anastomotic leakage were 39.8% versus 5.5% (p < 0.001), 2.7% versus 0% (p = 0.043), and 28.3% versus 5.5% (p < 0.001) in the NCRT group and NCT group, respectively.Multivariate analysis showed that only NCRT significantly increased the incidence of anastomotic leakage (odds ratio 7.28, 95% confidence interval 2.44-21.78,p < 0.001).Conclusions: The results show that NCRT can improve the pathological response rate but will increase the incidence of anastomotic leakage.Radiation dose-volume parameters were not associated with anastomotic leakage risk.