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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 12/2016

Open Access 01-11-2016 | Gastrointestinal Oncology

Using the Comprehensive Complication Index to Assess the Impact of Neoadjuvant Chemoradiotherapy on Complication Severity After Esophagectomy for Cancer

Authors: Nina Nederlof, MD, Annelijn E. Slaman, BSc, Pieter van Hagen, MD, Ate van der Gaast, MD, PhD, Ksenija Slankamenac, MD, PhD, Suzanne S. Gisbertz, MD, PhD, Jan J. B. van Lanschot, MD, PhD, Bas P. L. Wijnhoven, MD, PhD, Mark I. van Berge Henegouwen, MD, PhD, CROSS-Study Group

Published in: Annals of Surgical Oncology | Issue 12/2016

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Abstract

Background

Neoadjuvant chemoradiotherapy (nCRT) followed by surgery for patients with esophageal or junctional cancer has become a standard of care. The comprehensive complication index (CCI) has recently been developed and accounts for all postoperative complications. Hence, CCI better reflects the burden of all combined postoperative complications in surgical patients than the Clavien–Dindo score alone, which incorporates only the most severe complication. This study was designed to evaluate the severity of complications in patients treated with nCRT followed by esophagectomy versus in patients who underwent esophagectomy alone using the comprehensive complication index.

Study-design

All patients included in the CROSS trial—a randomized, clinical trial on the value of nCRT followed by esophagectomy—were included. Complications were assessed and graded using the Clavien–Dindo classification. CCI was derived from these scores, using the CCI calculator available online (www.​assessurgery.​com). CCI of patients who underwent nCRT followed by surgery was compared with the CCI of patients who underwent surgery alone.

Results

In both groups 161 patients were included. The median (and interquartile range) CCI of patients with nCRT and surgery was 26.22 (17.28–42.43) versus 25.74 (8.66–43.01) in patients who underwent surgery alone (p = 0.58). There also was no difference in CCI between subgroups of patients with anastomotic leakage, pulmonary complications, cardiac complications, thromboembolic events, chyle leakage, and wound infections.

Conclusions

Neoadjuvant chemoradiotherapy according to CROSS did not have a negative impact on postoperative complication severity expressed by CCI compared with patients who underwent surgery alone for potentially curable esophageal or junctional cancer.
Appendix
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Metadata
Title
Using the Comprehensive Complication Index to Assess the Impact of Neoadjuvant Chemoradiotherapy on Complication Severity After Esophagectomy for Cancer
Authors
Nina Nederlof, MD
Annelijn E. Slaman, BSc
Pieter van Hagen, MD
Ate van der Gaast, MD, PhD
Ksenija Slankamenac, MD, PhD
Suzanne S. Gisbertz, MD, PhD
Jan J. B. van Lanschot, MD, PhD
Bas P. L. Wijnhoven, MD, PhD
Mark I. van Berge Henegouwen, MD, PhD
CROSS-Study Group
Publication date
01-11-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 12/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5291-3

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