Neoadjuvant therapy has proven to be effective in the reduction of locoregional recurrence and mortality for
esophageal cancer. However, induction treatment has been reported to be associated with increased risk of postoperative complications. We therefore compared outcomes after
esophagectomy for
esophageal cancer for patients who underwent
neoadjuvant therapy and patients treated with surgery alone. Using the American College of Surgeons National Surgical Quality Improvement Program database (2005-2011), we identified 1939 patients who underwent
esophagectomy for
esophageal cancer. Seven hundred and eight (36.5%) received
neoadjuvant therapy, while 1231 (63.5%) received no
neoadjuvant therapy within 90 days prior to surgery. Primary outcome was 30-day mortality, and secondary outcomes included overall and serious morbidity,
length of stay, and
operative time. Patients who underwent
neoadjuvant treatment were younger (62.3 vs. 64.7, P < 0.001), were more likely to have experienced recent
weight loss (29.4% vs. 15.9%, P < 0.001), and had worse preoperative hematological cell counts (white blood cells <4.5 or >11 × 10(9) /L: 29.3% vs. 15.0%, P < 0.001; hematocrit <36%: 49.7% vs. 30.0%, P < 0.001). On unadjusted analysis, 30-day mortality, overall, and serious morbidity were comparable between the two groups, with the exception of the individual complications of venous thromboembolic events and
bleeding transfusion, which were significantly lower in the surgery-only patients (5.71% vs. 8.27%, P = 0.027; 6.89% vs. 10.57%, P = 0.004; respectively). Multivariable and matched analysis confirmed that 30-day mortality, overall, and serious morbidity, as well as prolonged
length of stay, were comparable between the two groups of patients. An increasing trend of preoperative
neoadjuvant therapy for
esophageal cancer was observed through the study years (from 29.0% in 2005-2006 to 44.0% in 2011, P < 0.001). According to our analysis, preoperative
neoadjuvant therapy for
esophageal cancer does not increase 30-day mortality or the overall risk of postoperative complications after
esophagectomy.