Esophageal resection after neoadjuvant therapy: understanding the limitations of large database analyses

Determining the optimal timing of surgical resection for esophageal adenocarcinoma following neoadjuvant therapy has proven to be a challenging task, and the clinical implications for patients undergoing surgery at various time intervals remain elusive. In an effort to fill a gap in the current retrospective literature pertaining to this clinical question, we utilized the method of restricted cubic splines (RCS) to investigate the balance in this timing from a unique statistical perspective. Using the National Cancer Database (NCDB), we determined an inflection point of 56 days wherein an increased incidence of pathologic complete response was balanced with a decreased rate of overall survival (1).