Prolonged time-to-surgery after chemoradiotherapy improves preoperative quality of life in esophageal cancer

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Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus Published May 14, 2026 Medically reviewed May 14, 2026 Study authors: Holmén Anders, Murad Fahad, Nilsson Klara, Rouvelas Ioannis, Lindblad Mats, Szabo Eva, Halldestam In… PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider that prolonged time-to-surgery after chemoradiotherapy may improve preoperative quality of life but offers no long-term benefit.

This secondary endpoint analysis of a randomized controlled trial included 249 patients with locally advanced resectable esophageal cancer across multicenter settings. The intervention was prolonged time-to-surgery (10-12 weeks) after neoadjuvant chemoradiotherapy, compared to standard time-to-surgery (4-6 weeks). Health-related quality of life was the secondary outcome, assessed preoperatively and at 6 months to 5 years postoperatively.

For preoperative outcomes, 97 patients were assigned to the standard group and 95 to the prolonged group (of 192 available for analysis). The prolonged group showed improvement in global quality of life and physical functioning, and reductions in fatigue, coughing, dysphagia, odynophagia, pain, discomfort, and weight loss. No effect sizes, p-values, or confidence intervals were reported.

Postoperatively, benefits in health-related quality of life were observed at 6 months, but no significant differences were seen beyond 6 months during follow-up. Safety data, including adverse events, serious adverse events, discontinuations, and tolerability, were not reported.

Key limitations include this being a secondary endpoint analysis and quality of life data available for only 192 of 249 randomized patients. The practice relevance notes that prolonged time-to-surgery was associated with worse oncological outcomes from the primary endpoint analysis, supporting standard timing. Findings are associative and specific to the assessed outcomes and follow-up period.

Study Details

Study typeRct

Sample sizen = 249

EvidenceLevel 2

Follow-up6.0 mo

PublishedMay 2026

PMID42132923

View Original Abstract ↓

Standard time-to-surgery after neoadjuvant chemoradiotherapy for esophageal cancer has historically been 4-6 weeks. Observational studies have suggested improved oncological outcomes and health-related quality of life in patients after prolonged time-to-surgery. This study aimed to investigate whether prolonged time-to-surgery is associated with improved health-related quality of life compared to the standard interval. This study is a secondary endpoint analysis within the NeoRes II trial, in which patients with locally advanced resectable esophageal cancer were randomized to either standard time-to-surgery (4-6 weeks) or prolonged time-to-surgery (10-12 weeks). The primary endpoints have been reported previously. Health-related quality of life was assessed using the EORTC QLQ-C30 and QLQ-OG25 questionnaires at time of diagnosis, preoperatively, and at 6-months and 1-5 years postoperatively. A total of 249 patients were randomized of whom 192 were available for health-related quality of life analyses, with 97 (51%) assigned to standard time-to-surgery and 95 (49%) to prolonged time-to-surgery. The groups were well-matched regarding baseline characteristics. Preoperatively, within a week of the day of surgery, patients in the prolonged time-to-surgery group reported better global quality of life, improved physical functioning, and less fatigue, coughing, dysphagia, odynophagia, pain, discomfort, and weight loss compared to those in the standard time-to-surgery group. These benefits were observed at 6 months postoperatively, but not thereafter during follow-up, where no significant differences were observed. Although prolonged time-to-surgery was associated with better preoperative health-related quality of life, no such benefits were observed postoperatively. In addition, the results from the primary endpoint analysis suggested that longer time-to-surgery was associated with worse oncological outcomes. This, together with the results of the current sub-study, strongly supports that the standard time-to-surgery of 4-6 weeks should be recommended after neoadjuvant chemoradiotherapy for esophageal cancer.