Comparison of surgical safety among different comprehensive treatment models for adenocarcinoma of esophagogastric junction: a single-center cohort study

BACKGROUND: Neoadjuvant chemotherapy (NAC) and neoadjuvant chemoradiotherapy (nCRT) are increasingly used to treat adenocarcinoma of the esophagogastric junction (AEG). However, there is insufficient clinical evidence to compare surgical safety among the three comprehensive treatment models, including the surgery‑first model, NAC model, and nCRT model. Therefore, this study was designed to compare surgical safety of the three comprehensive treatment models. METHODS: This is a retrospective cohort study. From January 2012 to December 2018, 276 consecutive patients with Siewert II and III AEG (cT2-4NxM0) in the Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute were enrolled in this study. All these patients underwent surgery and were categorized into three groups: surgery‑first group, NAC group and nCRT group. Inverse probability of treatment weighting (IPTW) was applied to balance baseline characteristics between the three groups. RESULTS: The overall postoperative complication rate in nCRT groups was 59.6%, which was significantly higher than that in the surgery-first group (42.2%, P = 0.040) and the NAC group (39.3%, P = 0.027). Moreover, the rate of major postoperative complications differed significantly among the three groups (P = 0.011), with the nCRT group showing a notably higher incidence than the surgery-first group (P = 0.008) and the NAC group (P = 0.043). No significant differences in postoperative complication rates were found between the surgery-first group and the NAC group. After IPTW, nCRT was significantly associated with increased postoperative complication (weighed OR = 2.25, 95% CI: 1.13-4.50, P = 0.022), and major postoperative complications (weighed OR:3.27, 95% CI: 1.45-7.39, P = 0.005). Thoracoabdominal approach (weighed OR = 6.47, 95% CI: 1.44-29.13, P = 0.015), combined organ resection (weighed OR = 5.08, 95% CI: 1.66-15.51, P = 0.004), and operative time exceeding 240 min (weighed OR = 2.23, 95% CI: 1.20-4.12, P = 0.011) were also identified as independent risk factors for postoperative complications. CONCLUSIONS: Neoadjuvant chemotherapy did not increase the risk of postoperative complications. In contrast, nCRT was associated with worse postoperative complications. We should pay more attention to AEG patients receiving neoadjuvant chemoradiotherapy.