Neoadjuvant therapies for advanced esophageal cancer are widespreading: nearly 45% of the patients undergoing esophagectomy received neoadjuvant therapy in 2010 in the USA, doubling the number from 2005. The use of induction therapy prior to surgery is supported by several studies that have shown an effective improvement in the disease-free and overall-survival rate, without compromising the morbidity and mortality of the operation, at least in the setting of the high-volume specialized centers involved in the randomized trials. Not much is known if neoadjuvant therapy has a detrimental effect on esophagectomy when “all” centers involved in the surgical management of these patients are considered. Even less is known on the effect of induction therapy on the postoperative quality of life. Two articles in this issue of Diseases of the Esophagus deal with these topics.
In the first article1 the authors report their findings on 1939 patients who underwent esophagectomy between 2005 and 2010, using the American College of Surgeons National Quality Improvement Program database: neoadjuvant therapy did not increase the 30 days mortality nor the major morbidity after esophagectomy, and only an increase of the incidence of venous thromboembolism was observed.
In the second article2 , the Quality of Life (QoL) was assessed in 84 patients whithout induction therapy and in 47 with neoadjuvant therapy, before the treatment and at 3, 6, 12 and 24 months after surgery: QoL values were extremely reduced immediately after surgery but recovered slowly during the postoperative period to almost preoperative levels in many scores, with no significant differences related to the neoadjuvant therapy.
(Mungo B, Molena D, Stem D, Yang SC et al. Does neoadjuvant therapy for esophageal cancer increase postoperative morbidity or mortality Dis. Esoph. 2015; Hauser C, Patett C, von Schoenfels W et al Does neoadjuvant treatment before oncolgic esophgectomy affect the postoperative quality of life? a prospective, longitudinal outcome study. Dis Esoph. 2015;…)
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