Neoadjuvant chemotherapy followed by minimally invasive esophagectomy versus primary surgery for management of esophageal carcinoma: a retrospective study

There is no consensus about the combined therapeutic strategy for esophageal squamous cell carcinoma in China. The quality control and standardization of surgery procedures were far from satisfactory in past neoadjuvant chemotherapy trials, which may underestimate the survival benefits. Therefore, we tried to evaluate the survival benefit of paclitaxel plus platinum followed by minimally invasive esophagectomy with total two-field lymphadenectomy patterns versus primary surgery. Between 06/2011 and 12/2014, there were 279 consecutive patients who underwent minimally invasive esophagectomy with total two-field lymphadenectomy; 83 received neoadjuvant chemotherapy and 196 primary surgery. Propensity score matching was used to compare neoadjuvant chemotherapy patients and 76 matched primary surgery patients. Effectiveness of neoadjuvant chemotherapy, adverse events, complications after the operation, and survival rates were evaluated. After propensity score matching, and compared with primary surgery, neoadjuvant chemotherapy was significantly associated with a better survival (P = 0.049). The overall clinical response rate of neoadjuvant chemotherapy was 77.1%. The pathological response rate was 20.5%. There was no significant difference in complication rates between two groups. Neoadjuvant chemotherapy with paclitaxel plus platinum followed by minimally invasive esophagectomy and total two-field lymphadenectomy have better OS over the primary surgery without serious adverse events.