Evidence map›Paper›PMID 27020672›Full record

ArticleLangenbeck's archives of surgery2016

Neoadjuvant chemoradiotherapy may increase the risk of severe anastomotic complications after esophagectomy with cervical anastomosis.

Fredrik Klevebro, Signe Friesland, Mattias Hedman, Jon A Tsai, Mats Lindblad, Ioannis Rouvelas, Lars Lundell, Magnus Nilsson

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Article in Langenbeck's archives of surgery, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed
3.1field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 22 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 1 institution in 1 country.

Fredrik KlevebroDivision of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden. fredrik.klevebro@ki.se.ORCID http://orcid.org/0000-0002-1695-4103
Signe FrieslandDepartment of Oncology, Karolinska University Hospital, Stockholm, Sweden.
Mattias HedmanDepartment of Oncology, Karolinska University Hospital, Stockholm, Sweden.
Jon A TsaiDivision of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Mats LindbladDivision of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Ioannis RouvelasDivision of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Lars LundellDivision of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Magnus NilssonDivision of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institutet, and Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Karolinska University Hospital · SE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeNeoadjuvant chemoradiotherapy (nCRT) improves long-term survival for patients with esophageal cancer. On the other hand, there are indications that nCRT may increase the risk for postoperative morbidity. The aims of this study were to estimate the radiation exposure to the site of anastomosis on the gastric fundus and to assess whether nCRT affected the incidence or severity of cervical anastomotic complications.

methodsA retrospective cohort of patients with cancer of the esophagus or gastroesophageal junction, who were reconstructed with cervical anastomosis. The planned radiation dose to the site of the cervical anastomosis on the gastric fundus was estimated for each patient.

resultsThe analysis of the dose plans showed that 20 out of 22 (93 %) available patients received radiotherapy toward the planned site of the anastomosis in the region of the gastric fundus with doses ranging from 6 to 40 Gy. In the nCRT group, 12 out of 28 patients (43 %) had anastomotic complications compared to 16 out of 42 (38 %) in the non-RT group (p = 0.69). In the nCRT group, 39 % had anastomotic complications that led to a Clavien-Dindo grade of IVa or higher compared to 17 % in the non-RT group (p = 0.03). The OR for Clavien-Dindo grade IVa or worse was 6.0 (95 % CI 1.52-23.50).

conclusionThis small retrospective study suggests that nCRT exposes the future anastomotic site to doses of radiation that may impair healing of the subsequent cervical anastomosis. Our data further suggest that nCRT may increase the severity of cervical anastomotic complications, and this hypothesis needs to be tested in a large prospective study.

Indexed as

AgedAnastomosis, SurgicalCarcinomaChemoradiotherapy, AdjuvantEsophageal NeoplasmsEsophagectomyEsophagogastric JunctionFemaleHumansMaleMiddle AgedNeckNeoadjuvant TherapyPostoperative ComplicationsRetrospective StudiesAnastomotic complicationsEsophageal cancerNeoadjuvant chemoradiotherapy

Identifiers

PMID27020672
OpenAlexW2316681338

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.