Efficacy and Safety of Neoadjuvant Chemoradiotherapy Following Esophagectomy with Japanese-style Extended 3-Field Lymphadenectomy for Thoracic Esophageal Cancer

Abstract

Aim: We investigated the safety of adding Japanese-style extended 3-field lymphadenectomy in patients treated with neoadjuvant chemoradiotherapy (NACRT) for thoracic esophageal squamous cell carcinoma (TESCC). Furthermore, the efficacy of NACRT, as shown by the pathological and metabolic responses were determined. Patients and Methods: One hundred consecutive patients with cStage II-IV TESSC were enrolled. We analyzed the adverse events related to NACRT and surgical complications following surgery. Pathological responses to NACRT and the association between pCR and [¹⁸F]-fluorodeoxyglucose positron-emission tomography (FDG-PET) evaluation were investigated. Results: Adding Japanese-style extended 3-field lymph node dissection after NACRT did not increase serious surgical complications. Seventy-four percent of patients experienced grade 2-3 pathological response, with 25% achieving pCR. There was a significant relationship between the change from positive to negative findings on FDG-PET/CT and pCR. Conclusion: Transthoracic esophagectomy with Japanese-style extended 3-field lymph node dissection after NACRT is a safe and powerful treatment.