ORIGINAL ARTICLE – GASTROINTESTINAL ONCOLOGY
The Negative Survival Impact of Infectious Complications After
Surgery is Canceled Out by the Response of Neoadjuvant
Chemotherapy in Patients with Esophageal Cancer
Kazuki Kano, MD
1
, Toru Aoyama, MD, PhD
2
, Takaki Yoshikawa, MD, PhD
1
, Yukio Maezawa, MD
2
,
Tetsushi Nakajima, MD
1
, Tsutomu Hayashi, MD
1
, Takanobu Yamada, MD, PhD
1
, Tsutomu Sato, MD, PhD
2
,
Takashi Oshima, MD, PhD
2
, Yasushi Rino, MD, PhD
2
, Munetaka Masuda, MD, PhD
2
, Haruhiko Cho, MD, PhD
1
,
and Takashi Ogata, MD, PhD
1
1
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan;
2
Department of Surgery, Yokohama
City University, Yokohama, Japan
ABSTRACT
Background. This study was designed to investigate
whether postoperative infectious complications (ICs) are a
risk factor for the prognosis in esophageal cancer patients
who receive neoadjuvant chemotherapy by stratifying the
response to neoadjuvant chemotherapy.
Methods. The present study retrospectively examined
patients who received neoadjuvant chemotherapy followed
by esophagectomy between January 2011 and September
2015. Risk factors for overall survival (OS) were examined
by Cox proportional hazard analyses. Pathological
responders to neoadjuvant chemotherapy were defined as
those with a tumor disappearance of more than one-third of
the initial tumor. Postoperative ICs were defined using the
Clavien–Dindo classification.
Results. Of the 111 patients examined, 45 (40.5%)
developed postoperative ICs. A pathological response to
neoadjuvant chemotherapy was observed in 54 (48.6%)
patients. The multivariate analysis demonstrated that
postoperative ICs were a significant independent risk factor
for the OS (hazard ratio [HR] 2.359; 95% confidence
interval [CI] 1.057–5.263, p = 0.036). In the subset anal-
ysis, postoperative ICs were a marginally significant
independent risk factor for OS in the nonresponders (HR
2.862; 95% CI 0.942–8.696, p = 0.063) but not in the
responders (HR 0.867; 95% CI 0.122–6.153, p = 0.886).
Conclusions. These results suggested that the negative
survival impact of postoperative ICs can be canceled out in
esophageal cancer patients who respond to neoadjuvant
chemotherapy.
Esophageal cancer is the world’s eighth most-common
cancer and the sixth leading cause of death among can-
cers.
1
Curative resection is essential for curing esophageal
cancer. However, because the prognosis of esophageal
cancer treated with surgery alone is relatively poor, mul-
timodality treatments have been developed to improve the
survival.
2–8
Neoadjuvant chemotherapy and subsequent
surgery has been established as a standard treatment for
locally advanced esophageal cancer.
3,4
The purpose of
neoadjuvant chemotherapy is to eradicate systemic
micrometastases before radical surgery.
9,10
Recent studies have demonstrated that postoperative
infectious complications (ICs) are associated not only with
mortality but also poor survival in various types of
malignancies, including esophageal cancer.
11–16
Esopha-
geal cancer surgery frequently causes postoperative ICs, at
rates as high as 30–65%.
17,18
This may be one reason for
the relatively poor survival associated with this cancer.
Some studies have reported that postoperative ICs nega-
tively affect the prognosis, even in esophageal cancer
patients who receive primary surgery and undergo neoad-
juvant chemotherapy, which suggests that postoperative
Kazuki Kano and Toru Aoyama equally contributed to this article.
Ó Society of Surgical Oncology 2018
First Received: 26 December 2017;
Published Online: 10 May 2018
T. Yoshikawa, MD, PhD
e-mail: tayoshik@ncc.go.jp
T. Ogata, MD, PhD
e-mail: ogatat@kcch.jp
Ann Surg Oncol (2018) 25:2034–2043
https://doi.org/10.1245/s10434-018-6504-8
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