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Background Esophago-gastric junctional (EGJ) cancers have been considered recently as distinct tumour entity with characteristic genetic profiles. However, the optimal multimodal therapy of advanced EGJ cancers is still debatable. In this comparative study, we analysed the outcomes of peri-operative chemotherapy (CT) versus pre-operative chemoradiotherapy (CRT) in treatment of advanced EGJ adenocarcinomas. Methods This study included patients with locally advanced but resectable EGJ adenocarcinomas who underwent surgical resection after oncological therapy between 2010 till 2019, at our institution. Follow up till May 2021 was done. The outcomes between CT and CRT groups were retrospectively analysed. The long-term follow up data was obtained via direct contact with the patients during our oncological clinics, cross-checked with our hospital/national patients’ electronic databases. Results 107 patients had EGJ cancers; 90 (84%) patients met our inclusion criteria. Peri-operative chemotherapy was received in 65 (72%) patients. Overall median survival rate was 2.2 years in CRT-group compared to 2.4 years in CT-group (p-value 0.29), with comparable recurrence rates (48% vs 36% respectively). R0-resections were higher in CRT-group (84%) compared to CT-group (71%), yet insignificant p-value 0.197. Preoperative chemoradiotherapy achieved higher complete pathological response (28% vs 6%, p-value 0.009) and negative lymph nodes rates (64% vs 37%, p-value 0.014) compared to CT-group. Short-term outcomes (postoperative complications, morbidity rates and length of hospital stay) were similar across both groups. Conclusions Preoperative chemoradiotherapy was associated with higher complete pathological response and negative lymph nodes rates for EGJ adenocarcinomas compared to peri-operative chemotherapy, without increase in postoperative complications or morbidity rates. However, it wasn’t associated with improved overall or disease-free survival rates. These findings supported the use of CRT in treatment of advanced EGJ adenocarcinomas.

british journal of surgery

O-OGC04 Peri-operative chemotherapy versus preoperative chemoradiotherapy in treatment of Esophago-gastric junctional adenocarcinomas: A 10-year cohort study