Impact of Timing on Post-Operative Outcomes in Esophagectomy for Squamous Cell Carcinoma: A Prospective Observational Study Comparing Surgery Within 8 Weeks vs. After 8 Weeks Post-Neoadjuvant Chemotherapy in a North Indian Tertiary Care Centre

Abstract Purpose-: Neoadjuvant chemotherapy followed by esophagectomy is the usual approach to manage esophageal squamous cell carcinoma (ESCC). The optimal interval to operate after completion of Neoadjuvant Chemo-radiotherapy (NACRT) still remains controversial. Methods:A prospective study was conducted to observe and compare post-operative complications and pathological outcomes in patients with squamous cell carcinoma of the esophagus who underwent NACRT followed by surgery within 8 weeks or after 8 weeks of NACRT completion. The pathological complete response was assessed using Mandard tumour regression grade. Morbidity and mortality were compared and were graded using Clavien-Dindo scale. Results: The Study included 50 patients, 19 patients in within 8 week group study. Patients underwent thoracoscopy assisted esophagectomy with neoesophagus formation using gastric conduit. There was a significant difference between mortality between the two groups, with three mortalities in <8 week group and none in the other group (p=0.022). Postoperative complications and pathological outcomes did not have a statistically significant difference between the two groups. Conclusion: The rate of post-operative complications and pathological response in ESCC cases do not appear to be impacted by the interval between NACRT and surgery; nevertheless, early surgery was associated with a higher risk of mortality.