Optimal Surgery Timing After Chemo in Esophageal Cancer?

M. Alexander Otto, PA, MMS

December 23, 2022

The study covered in this summary was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Esophagectomy for esophageal squamous cell carcinoma (ESCC) should be performed 6–8 weeks after the end of neoadjuvant chemotherapy.

Why This Matters

  • Neoadjuvant chemotherapy followed by esophagectomy is the standard treatment for ESCC.

  • The optimal timing between neoadjuvant chemotherapy and surgery has not yet been established.

  • In the current investigation, researchers reported that the sweet spot is 6–8 weeks for optimal survival outcomes, a clinically useful finding.

Study Design

  • The team retrospectively assessed 97 patients who had undergone radical, minimally invasive esophagectomy after docetaxel/cisplatin/5-fluorouracil/capecitabine neoadjuvant chemotherapy.

  • The researchers compared outcomes on the basis of the timing of surgery, which came 16–41 days after neoadjuvant chemotherapy for 33 patients, 42–55 days (or 6–8 weeks) later for 29 patients, and 56–135 days later for 35 patients.

  • The three groups were similar in terms of age, sex, body mass index, performance score, comorbidities, and tumor characteristics. Most patients had undergone cycles of neoadjuvant chemotherapy; one third had received three cycles.

  • The mean age of the patients was 60 years, and nearly all were men. Median follow-up was 24 months.

Key Results

  • Compared with the 6- to 8-week arm, the earlier surgery group had the worst outcomes for both overall survival (hazard ratio [HR], 3.36) and progression-free survival (HR, 3.27).

  • The later surgery group also had worse overall survival (HR, 1.83) and progression-free survival (HR, 1.61) compared with the 6- to 8-week arm.

  • Overall survival at about 4 years was highest in the 6- to 8-week group ― 75%; it was about 50% in the early group and 60% in the later group.

  • In addition, 3-year progression-free survival was about 70% in the 6- to 8-week group, 33% in the early group, and 55% in the later group.

  • Rates of severe postoperative complications were lower for the patients who underwent surgery at 6–8 weeks.

  • The number of neoadjuvant chemotherapy cycles differed between the groups; the more cycles patients received, the longer the time to surgery.


  • It was an observational study with a relatively small patient population.

  • It is unclear why some patients underwent surgery earlier and others later.

  • Although the team tried to minimize imbalances by multivariable analyses, potential bias could not be ruled out.


  • No funding for the work was reported, and the investigators did not disclose relevant financial relationships.

This is a summary of a preprint research study, "Effect of Time to Minimally Invasive Esophagectomy After Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma," led by Nguyen Vo Vinh Loc of the University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam, provided to you by Medscape. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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