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Salvage esophagectomy for initially unresectable locally advanced T4 esophageal squamous cell carcinoma

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Abstract

Background

Definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC) is a potentially curative treatment modality, even for patients with unresectable T4 tumors. For patients who fail dCRT, salvage esophagectomy is known to be a high-risk procedure. However, the efficacy and safety of salvage surgery for these patients remain unclear.

Methods

A total of 35 patients who underwent salvage esophagectomy after dCRT for initially unresectable locally advanced T4 ESCC were assessed, and both outcomes and prognostic factors after surgery were investigated.

Results

Among the study population, R0 resection was achieved in 19 patients (54.3%). Postoperatively, 8 patients (22.9%) experienced Clavien–Dindo grade IIIb or higher complications, and 3 patients (8.6%) registered surgery-related mortality. Overall survival rates were 45.7%, 28.6%, and 5.7% at 1, 2, and 5 years, respectively. In Cox regression analysis, residual or relapsed tumor limited to T2 or less was an independent prognostic factor for better survival (P = 0.010). On the other hand, postoperative pneumonia and incomplete resection were negative prognostic factors (P < 0.001 and P = 0.019, respectively). Nodal involvement and extent of lymph node dissection did not impact patient survival.

Conclusions

Although salvage esophagectomy for initially unresectable T4 ESCC is considered a high-risk surgery with poor prognosis, long-term survival may be achieved in patients with ≤ T2 residual tumors. In addition, R0 resection and postoperative pneumonia prevention are crucial to improve patient survival.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Gastroenterology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Akihiko Okamura, Masaru Hayami, Ryotaro Kozuki, Keita Takahashi, Tasuku Toihata, Yu Imamura & Masayuki Watanabe

  2. Department of Esophageal and Gastroenterological Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Shinji Mine

Authors
  1. Akihiko Okamura
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  2. Masaru Hayami
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  3. Ryotaro Kozuki
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  4. Keita Takahashi
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  5. Tasuku Toihata
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  6. Yu Imamura
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  7. Shinji Mine
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  8. Masayuki Watanabe
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Correspondence to Masayuki Watanabe.

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All procedures were performed in accordance with the ethical standards of our institutional review board and with the Helsinki Declaration of 1964 and later versions. All authors followed the policy concerning Informed Consent.

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All authors declare that they have no conflict of interest.

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Okamura, A., Hayami, M., Kozuki, R. et al. Salvage esophagectomy for initially unresectable locally advanced T4 esophageal squamous cell carcinoma. Esophagus 17, 59–66 (2020). https://doi.org/10.1007/s10388-019-00700-0

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  • DOI: https://doi.org/10.1007/s10388-019-00700-0

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