Skip to main content
SpringerLink
Log in

Appropriate Candidates for Salvage Esophagectomy of Initially Unresectable Locally Advanced T4 Esophageal Squamous Cell Carcinoma

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Standard treatment for unresectable locally advanced esophageal cancer is definitive chemoradiotherapy (dCRT). Although salvage esophagectomy is the only curative treatment available following dCRT failure, the appropriate candidates for salvage esophagectomy remain unclear.

Patients and Methods

Three hundred seventeen patients who underwent dCRT from April 2004 to December 2016 were stratified into three study groups—a complete response (CR) group, chemotherapy or best supportive care (BSC) group, and salvage esophagectomy group—and compared. We also investigated the clinical outcomes and prognostic factors of salvage esophagectomy.

Results

Seventy-one patients (22.4%) achieved CR after dCRT, 18 patients (5.7%) underwent salvage esophagectomy, and 228 patients (71.9%) underwent palliative chemotherapy or BSC. The 5-year overall survival (OS) rates of the CR group, salvage esophagectomy group, and chemotherapy or BSC group were 83.0%, 51.6%, and 1.3%, respectively. Salvage esophagectomy recipients had a worse OS rate than CR patients (p < 0.001) but a better OS rate than those in the chemotherapy or BSC group (p < 0.001). Incomplete resection was the only significant variable associated with poor OS on univariate Cox proportional-hazards analysis (hazard ratio: 7.633, 95% confidence interval: 1.692–34.482; p = 0.008). Patients with tumors in the upper thoracic esophagus were more likely to undergo incomplete resection (p = 0.011).

Conclusions

Patients who achieve R0 resection are good candidates for salvage esophagectomy regardless of their response to dCRT. Those with upper thoracic esophageal tumors are at risk of incomplete resection; careful attention is required when considering these patients for salvage esophagectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108.

    Article  Google Scholar 

  2. Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg. 2000;232:225–32.

    Article  CAS  Google Scholar 

  3. Kawakami T, Tsushima T, Omae K, et al. Risk factors for esophageal fistula in thoracic esophageal squamous cell carcinoma invading adjacent organs treated with definitive chemoradiotherapy: a monocentric case-control study. BMC Cancer. 2018;18:573.

    Article  Google Scholar 

  4. Ohtsu A, Boku N, Muro K, et al. Definitive chemoradiotherapy for T4 and/or M1 lymph node squamous cell carcinoma of the esophagus. J Clin Oncol. 1999;17:2915–21.

    Article  CAS  Google Scholar 

  5. Okamura A, Hayami M, Kozuki R, et al. Salvage esophagectomy for initially unresectable locally advanced T4 esophageal squamous cell carcinoma. Esophagus. 2019. https://doi.org/10.1007/s10388-019-00700-0

    Article  PubMed  Google Scholar 

  6. Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 1. Esophagus. 2019;16:1–24.

    Article  Google Scholar 

  7. Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 2. Esophagus. 2019;16:25–43.

    Article  Google Scholar 

  8. Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors: International Union against Cancer. 8th ed. Oxford: Wiley; 2017.

    Google Scholar 

  9. Shinoda M, Ando N, Kato K, et al. Randomized study of low-dose versus standard-dose chemoradiotherapy for unresectable esophageal squamous cell carcinoma (JCOG0303). Cancer Sci. 2015;106:407–12.

    Article  CAS  Google Scholar 

  10. Therasse P, Arbuck SG, Eisenhauer EA, et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst. 2000;92:205–16.

    Article  CAS  Google Scholar 

  11. Eisenhauer E, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.

    Article  CAS  Google Scholar 

  12. Japan Esophageal Society. Japanese classification of esophageal cancer, 11th ed. Part II and III. Esophagus. 2017;14:37–65.

    Article  Google Scholar 

  13. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  Google Scholar 

  15. Tachimori Y, Kanamori N, Uemura N, Hokamura N, Igaki H, Kato H. Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg. 2009;137:49–54.

    Article  Google Scholar 

  16. Watanabe M, Mine S, Nishida K, et al. Salvage esophagectomy after definitive chemoradiotherapy for patients with esophageal squamous cell carcinoma: Who really benefits from this high-risk surgery? Ann Surg Oncol. 2015;22:4438–44.

    Article  Google Scholar 

  17. de Manzoni G, Pedrazzani C, Pasini F, et al. Chemoradiotherapy followed by surgery for squamous cell carcinoma of the thoracic esophagus with clinical evidence of adjacent organ invasion. J Surg Oncol. 2007;95:261–6.

    Article  Google Scholar 

  18. Ikeda K, Ishida K, Sato N, et al. Chemoradiotherapy followed by surgery for thoracic esophageal cancer potentially or actually involving adjacent organs. Dis Esophagus. 2001;14:197–201.

    Article  CAS  Google Scholar 

  19. Ohkura Y, Ueno M, Iizuka T, Udagawa H. Prognostic factors and appropriate lymph node dissection in salvage esophagectomy for locally advanced T4 esophageal cancer. Ann Surg Oncol. 2019;26:209–16.

    Article  Google Scholar 

  20. Booka E, Takeuchi H, Nishi T, et al. The impact of postoperative complications on survivals after esophagectomy for esophageal cancer. Medicine. 2015;94:e1369.

    Article  Google Scholar 

  21. Booka E, Takeuchi H, Suda K, et al. Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer. BJS Open. 2018;2:276–84.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Divisions of Esophageal Surgery, Shizuoka Cancer Center Hospital, Nagaizumi, Japan

    Eisuke Booka MD, PhD, Ryoma Haneda MD, Kenjiro Ishii MD, PhD & Yasuhiro Tsubosa MD, PhD

  2. Gastrointestinal Oncology, Shizuoka Cancer Center Hospital, Nagaizumi, Japan

    Takeshi Kawakami MD, Takahiro Tsushima MD & Hirofumi Yasui MD

  3. Radiation Oncology and Proton Therapy, Shizuoka Cancer Center Hospital, Nagaizumi, Japan

    Tsuyoshi Onoe MD & Hirofumi Ogawa MD

  4. Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Ryoma Haneda MD

Authors
  1. Eisuke Booka MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryoma Haneda MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenjiro Ishii MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takeshi Kawakami MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takahiro Tsushima MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hirofumi Yasui MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tsuyoshi Onoe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hirofumi Ogawa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yasuhiro Tsubosa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yasuhiro Tsubosa MD, PhD.

Ethics declarations

Disclosure

The authors declare that they have no conflicts of interest or funding to report in relation to this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Booka, E., Haneda, R., Ishii, K. et al. Appropriate Candidates for Salvage Esophagectomy of Initially Unresectable Locally Advanced T4 Esophageal Squamous Cell Carcinoma. Ann Surg Oncol 27, 3163–3170 (2020). https://doi.org/10.1245/s10434-020-08440-7

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-08440-7

Search

Navigation