Impact of Interval to Esophagectomy After Neoadjuvant Immunochemotherapy for Locally Advanced Esophageal Squamous Cell Carcinoma: A Multicenter Retrospective Cohort Analysis

Background: Neoadjuvant chemoimmunotherapy (nICT) has emerged as a novel and promising treatment model for esophageal squamous cell carcinoma (ESCC). However, the optimal interval to esophagectomy after nICT remains unclear. This study aimed to explore the impact of a prolonged interval (7-10 weeks) on short- and long-term outcomes compared to the standard interval (4-6 weeks). Methods: This was a multicenter retrospective cohort analysis, including three centers. Patients were diagnosed with locally advanced ESCC (cT3-4a or cN+) and received radical resection after at least one cycle of nICT. The primary outcomes were pathological response, disease-free survival (DFS), and overall survival (OS). Inverse probability of treatment weighting (IPTW) was utilized to balance the baseline characteristics. Results: One hundred and seventy patients were included in the study, with 123 in the standard interval group and 47 in the prolonged interval group. After IPTW, the prolonged interval group exhibited a higher pathological complete response (pCR) than the standard group, but the difference was not statistically significant (29.5% vs. 41.5%, p = 0.306). Additionally, although the 3-year DFS and OS rates were higher in the prolonged interval group, these differences did not reach statistical significance. There were no statistically significant variances observed in terms of intraoperative blood loss, surgical time, postoperative hospital stays, duration of thoracic drainage tube placement, hospital expenses, or postoperative complications. Conclusions: Patients demonstrated tolerance for esophagectomy within 4-6 weeks after nICT. Based on the present findings regarding pCR, DFS, and OS, extending the time to surgery beyond 6 weeks was found to be acceptable.