Cancelation of surgery was significantly more common in patients with a squamous cell carcinoma, and this histology seems to represent a more complex oncological and functional entity. As a result, the relative weight of medical inoperability increased, indicating the importance of upfront testing of medical operability. Over time, irresectability as reason decreased. One in six patients starting neoadjuvant treatment for locally advanced esophageal cancer never made it to esophagectomy, more than half of them for oncological reasons, but also 1.3% because of death during treatment. They had a median overall survival of 33.2 months.

The majority of patients refusing surgery had a clinical complete response (73.3%). Median overall survival was, respectively, 12.5 and 9.9 months for adenocarcinoma and squamous cell carcinoma patients ( p = 0.441). Irresectability ( p = 0.032), patients’ refusal ( p = 0.012), and poor general condition ( p = 0.002) were more frequent as reasons for cancelation in squamous cell carcinoma patients. Median overall survival was not different over time (9.2 versus 12.5 months p = 0.937). In the second time period, there were less irresectable tumors (17.7% versus 5.8% p = 0.044). Reasons for cancelation were disease progression (50 patients, 43.9%), poor general condition (26 patients, 22.8%), irresectability (14 patients, 12.3%), patients’ own decision (15 patients, 13.2%), and death during neoadjuvant treatment (9 patients, 7.9%).

In 114 of 679 patients (16.8%), surgery was not performed after neoadjuvant treatment. Subanalysis was performed according to time period (2002–2010 versus 2011–2015) and histology (adenocarcinoma versus squamous cell carcinoma). We retrospectively analyzed patients treated between 20 for locally advanced esophageal cancer, who did not undergo esophagectomy after neoadjuvant treatment. The purpose of our study was to investigate the group of patients, scheduled for neoadjuvant treatment followed by esophagectomy, who never made it to esophageal resection. However, not all patients who started neoadjuvant treatment will undergo esophageal resection. Neoadjuvant treatment followed by esophagectomy is standard practice in locally advanced esophageal cancer.

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