The Impact of Timing of Esophagectomy After Neoadjuvant Chemoradiotherapy on Pathological Outcomes and Survival in Patients with Pure Esophageal Squamous Cell Carcinoma

The scheduling of esophagectomy following neoadjuvant chemoradiotherapy (nCRT) for patients with ESCC continues to be a highly debated topic, with no universal consensus on the ideal surgical timeframe. Traditional 6–8 week intervals are often based on historical habits rather than histological evidence. This study evaluates the clinical impact of surgical timing on OS and pCR rates, specifically questioning the validity of fixed calendar-based protocols. By analyzing a consistent cohort of ESCC cases, we aim to identify a more nuanced and secure timeframe for post-nCRT interventions. A retrospective investigation was performed on a series of 68 patients with ESCC who received standardized nCRT and subsequent esophagectomy during the period spanning June 2022 to November 2025. To ensure methodological purity and eliminate histological confounding, adenocarcinoma patients were excluded. The surgical interval was analyzed as a continuous variable and dichotomized at a 10-week threshold to address statistical power concerns. Logistic regression was utilized to assess predictors of pCR. Similarly, Cox regression models were employed for OS analysis, including both univariate and multivariate variables to ensure a robust evaluation. The mean surgical interval was 11.17 ± 5.25 weeks (median: 10.7), with 54.4% of patients waiting more than 10 weeks. Our analysis revealed that surgical timing had no significant impact on pCR rates ( p =0.208) or overall survival (log-rank p =0.244). Instead, baseline clinical T stage (OR: 0.26, p =0.029) and distal tumor location (OR: 3.51, p =0.034) emerged as the only independent predictors of response. The 24-month OS was 67.8% for the ≤10-week group vs. 85.1% for the >10-week group ( p =0.244), confirming that extended delays do not compromise oncologic safety. Incidences of severe postoperative complications and 30-day mortality remained comparable, with no significant differences noted. In ESCC, tumor biology not the calendar is the ultimate arbiter of response . Our findings demonstrate that a flexible surgical window of up to 10 weeks or more is oncologically safe and provides a crucial period for clinical optimization of "frailer" patients recovering from nCRT toxicities. This study supports shifting from rigid schedules toward a biology-driven, personalized surgical timing strategy in ESCC management.