Audit of Postoperative Complications According to Pathological Response After Trimodality Therapy in Oesophageal Cancer

Background Trimodality approach with Neoadjuvant chemoradiation therapy and surgery is the preferred approach for resectable squamous carcinoma of oesophagus. The aim of this study was to correlate the significance of difference in postoperative complications with respect to pathologic complete responders (pCR) and pathological residual disease after surgery. Methods Consecutive patients with operable oesophageal cancer, who received neoadjuvant chemoradiation followed by oesophageal surgery between March 2013 to January 2025 were included. Data was extracted from electronically and physically maintained patient clinical records. Data was collected in mircosoft excel and analysed using Epi Info Version 7.2. Chi square test and student t test were used to test the difference between proportions and means respectively. All tests were 2 tailed and significance level was 0.05. Various demographic, clinical and treatment outcome parameters were analysed according to pathological complete responders (pCR)and pathological residual disease. Results Total 167 patients completed trimodality therapy. Out of 167 patients, 139(88.04%) had squamous carcinoma histology and rest were adenocarcinoma. Among 167 patients, 92(55.1%) had pCR. Postoperative complications were seen in 36 (40%) of pCR group as compared to 17(22.1%) in partial responders (p = 0.039). Pulmonary 18(20%) vs 9(11.7%), Cardiac 7(7.8%) vs 5(6.5%) and vocal cord palsy 11(12.2%) vs 9(11.7%) complications were seen in pCR vs partial responders respectively. Conclusion Pathological complete responders had significantly more postoperative complications as compared to partial responders, which point us to introspect reasons with regard to neo-adjuvant radiation doses to lung and heart and mandates to implement strict ERAS program including stringent cardio-pulmonary prehabilitation protocol.