Real-World Deliverability of Adjuvant Nivolumab After Esophagectomy: Treatment Initiation, Completion, and Postoperative Complications

Purpose Evidence on the practical delivery of adjuvant nivolumab after neoadjuvant chemotherapy and esophagectomy remains limited. We described treatment initiation and completion in routine practice and explored their associations with postoperative complications. Methods This single-center retrospective study included 25 patients who initiated adjuvant nivolumab after neoadjuvant treatment and R0 esophagectomy in 2022–2025. Twenty patients treated with postoperative S-1 in 2011–2023 constituted a nonconcurrent, descriptive reference cohort. The outcomes were time from surgery to treatment initiation, 1-year treatment completion, reasons for discontinuation, and adverse events. Survival analyses were exploratory. Results Median time to treatment initiation was 77 days with nivolumab and 67 days with S-1. Among nivolumab recipients, the median interval was longer in patients with Clavien–Dindo grade ≥II complications than in those without (113.0 vs 69.5 days; p = 0.008), and in those with grade ≥III complications than in those without (132.0 vs 74.5 days; p = 0.027). Ten of 25 patients (40.0%) completed 1 year of nivolumab; one was still receiving treatment at the cutoff. Recurrence and adverse events each led to discontinuation in six patients (24.0%). Grade ≥3 immune-related adverse events occurred in six patients (24.0%). Conclusion Among patients who started adjuvant nivolumab, postoperative complications were associated with later treatment initiation, and recurrence and adverse events frequently prevented completion. These descriptive findings require confirmation in larger multicenter cohorts and do not establish the impact of treatment timing on survival.