Massachusetts Chapter of the American College of Surgeons

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Do sociodemographic factors impact timing of esophagectomy after neoadjuvant therapy?
Ashley L. Deeb, MD1, Aaron R. Dezube, MD1, Luis E. De Leon, MD1, Suden Kucukak, MD1, Michael T. Jaklitsch, MD1, Jon O. Wee, MD1
1Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA

Timely esophagectomy after neoadjuvant therapy (CRT) is associated with improved outcomes. We investigated whether sociodemographic factors impacted this timing.

We included patients with pT0-3N0+ esophageal cancers who underwent CROSS trimodality therapy from May 2016 to January 2020. Differences in surgery within 60 days were analyzed by sociodemographic and neoadjuvant factors.

197 patients were analyzed. 137 underwent esophagectomy within 60 days (early surgery, ES) and 60 were outside that window (delayed surgery, DS). Delayed surgery (DS) patients were older (68.45 years (IQR 10.08) vs. median 65.82 years (IQR 13.00), p=0.01) and more were smokers (86.67% vs. 66.42%, p=0.003). A smaller portion of DS patients received CRT at Dana Farber (DFCI) or a DFCI satellite site (20.00% DFCI and 13.33% satellite vs. 32.85% DFCI and 25.55% satellite, p=0.01). Similarly, less DS patients saw our surgeons before CRT completion (68.33% vs 89.78%, p=0.00). More DS patients required neoadjuvant dose reduction (16.67% vs. 6.57%, p=0.04). In univariable logistic regression, CRT at DFCI (OR 2.63 95% CI 1.24-5.59, p=0.01) or satellite (OR 3.07, 95% CI 1.29-7.31, p=0.01) and evaluation by thoracic surgery (OR 4.07 95% CI 1.87-8.84, p=0.00) favorably impacted time to esophagectomy. History of MI (OR 0.29, 95% CI 0.09-0.94, p=0.04), cerebrovascular disease (OR 0.29, 95% CI 0.09-0.94, p=0.04), smoking (OR 0.3, 95% CI 0.13-0.69, p=0.01), and CRT dose reduction (OR 0.35, 95% CI 0.13-0.92, p=0.03) negatively impacted timely esophagectomy.

Early consultation with our surgeons and CRT location might improve timeliness of esophagectomy.

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