Drivers of 30-/90-day post-op mortality following neoadjuvant chemoradiation for esophageal cancer

Abstract Background Neoadjuvant chemoradiation followed by esophagectomy is a standard of care for locally advanced esophageal cancers. The CROSS trial reported a 30-day mortality rate of 6%. We sought to evaluate 30- and 90-day mortality in similar patients in the United States and identify predictors of higher mortality rates. Methods The National Cancer Database was used to identify patients with cT3-4/N+ esophageal cancers treated with neoadjuvant chemoradiation followed by esophagectomy. Bivariate univariable and multivariable regression analysis was utilized to identify predictors of 30- and 90-day mortality. Results 7,691 patients were identified. Readmission within 30 days of surgery occurred in 6.0% of patients. Thirty and ninety-day mortality was 2.9% and 7.2%. Positive surgical margins conferred a more than doubled risk of 30- and 90-day mortality, 5.5% vs 2.7% and 14.6% vs 6.8% (both p Conclusions Post-operative mortality at 30 and 90 days following neoadjuvant chemoradiation and esophagectomy appear to be on par with randomized data. Positive surgical margins, squamous cell carcinomas, age 69 and over, readmission within 30 days and conversion from a minimally-invasive surgery to open all carry a 90-day mortality risk > 10%.