AB049. SOH25_AB_303. Surgery or active surveillance for esophageal cancer patients with a clinical complete response to neoadjuvant chemoradiation; outcomes of patient-led decision-making
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AB049. SOH25_AB_303. Surgery or active surveillance for esophageal cancer patients with a clinical complete response to neoadjuvant chemoradiation; outcomes of patient-led decision-making

Níamh Smyth1, Natallia Kharytaniuk2, Abhi Narsiman1, Jan Sorensen3, Arnold Hill4, Thomas Walsh2

1Department of Surgery, Royal College of Surgeons, Dublin, Ireland; 2Department of Surgery, Connolly Hospital Blanchardstown, Dublin, Ireland; 3Healthcare Outcomes Research Centre, Royal College of Surgeons, Dublin, Ireland; 4Department of Surgery, Beaumont Hospital, Beaumont, Dublin, Ireland

Background: Over half of esophageal cancer patients show a clinical complete response (cCR) to neoadjuvant chemo-radiation (NCR), with the majority also having a pathological complete response (pCR). Currently, patients with pCR cannot be accurately distinguished from those with cCR alone preoperatively. At present, guidelines mandate resection for all esophageal cancer patients, regardless of response, but the risks of esophagectomy are significant with most patients reporting life-long quality of life impairment. We hypothesised that patients with a cCR could be offered an informed choice between surgery and active surveillance without impairing survival.

Methods: One hundred fifty-two esophageal cancer patients receiving NCR were included. Following restaging eighty (52%) showed a cCR to NCR. All cCR patients were offered an informed choice between surgery and active surveillance.

Results: Fifty-one patients (63.75%; mean age 58 years) with a cCR chose surgery and twenty-nine (36.25%; mean age 70 years) chose active surveillance. Seven (24.1%) of the surveillance cohort developed locoregional recurrence, six of whom consented to salvage esophagectomy. A 17% higher mortality at 12-months was observed in the surgery group. Across a 5-year follow-up period, and with adjustments for the 12-year age difference between groups, the mean survival for the surgery cohort was 37.2 months [95% confidence interval (CI): 29.7–44.6] and for the active surveillance cohort was 37.0 months (95% CI: 26.3–47.6).

Conclusions: Our results support the potential for patient-led decision-making protocol for esophageal cancer patients with cCR to NCR therapy.

Keywords: Choice; active surveillance; surgery; esophageal cancer; survival

Acknowledgments

None.

Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-25-ab049
Cite this abstract as: Smyth N, Kharytaniuk N, Narsiman A, Sorensen J, Hill A, Walsh T. AB049. SOH25_AB_303. Surgery or active surveillance for esophageal cancer patients with a clinical complete response to neoadjuvant chemoradiation; outcomes of patient-led decision-making. Mesentery Peritoneum 2025;9:AB049.

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