367. IMPACT OF NEOADJUVANT IMMUNOTHERAPY ON POSTOPERATIVE COMPLICATIONS IN RESECTABLE ESOPHAGEAL ADENOCARCINOMA

Abstract Background Several studies are ongoing on the use of immunotherapy in the neoadjuvant setting for esophageal and gastroesophageal junction cancer but it is unclear the effect of an increased activation of the immune system on surgery and the postoperative course. Methods This multicenter retrospective cohort study included data from 3 high-volume centers for upper-GI surgery. Only patients with esophageal adenocarcinoma who underwent neoadjuvant therapy and radical surgery between 2015 and 2022 were included. Clinical characteristics and the postoperative outcomes were compared between patients who received standard neoadjuvant therapy or chemotherapy plus immunotherapy. A 1-to-1 matched comparison was also performed. The difference in overall survival (OS) and disease free survival (DFS) between the two groups was also evaluated. Results Overall, 563 patients were included and 21 received preoperative Pembrolizumab or Trastuzumab combined with at least a couple of chemotherapy drugs. The incidence of complications was 47% in the group with immunotherapy and 40.7% in the other group (p=0.53). The matched analysis confirmed no differences in rate of complications (p>0.99), gravity of complications (p=0.17) and pulmonary complications (p>0.99). Anastomotic leak rate was 4.7% in the immunotherapy group and 19% in the other one (p=0.34). Overall survival and disease free survival were comparable (respectively p=0.4 and p=0.9) also after the matched analysis (respectively p=0.15 and p=0.52). Conclusion Neoadjuvant immunotherapy-based regimen does not affect the postoperative course, in particular it does not appear to aggravate the major complications of esophagectomy.