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 

作者机构：Upper GI SurgeryConcord Repatriation General HospitalSydney 2137NSWAustralia Department of MedicineUniversity of Notre DameSydney 2007NSWAustralia CNI Molecular ImagingNotre Dame UniversitySydney 2114NSWAustralia 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2021年第13卷第10期

页      面：1235-1244页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Oesophagectomy Oesophageal adenocarcinoma Neoadjuvant chemotherapy Lymphadenectomy Survival outcome Surgical technique 

摘      要：BACKGROUND Neoadjuvant chemotherapy(NACT)and oesophagectomy is the standard of care for resectable oesophageal *** outcomes following resection have been improving over time while NACT remain largely ***,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 *** 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 *** Patient data were analysed from a prospectively maintained surgical survival ***,surgical,and survival outcomes were compared between groups according to treatment and nodal *** The data of 243 consecutive patients were identified.79 patients were given NACT and 162 had surgery *** NACT group were younger,and there was less frequent stage I *** 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,and30 in 197 patients,but were otherwise *** was improved survival in patients with≥30 nodes removed than those with30 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 ***,an overall survival benefit was observed in patients with≥30 lymph nodes removed,and a benefit in disease-free survival which was not significant.