World Journal of Surgery

, Volume 34, Issue 2, pp 277–284 | Cite as

Factors Influencing the Long-Term Survival in Patients with Esophageal Cancer Who Underwent Esophagectomy After Chemoradiotherapy

  • Hiroya TakeuchiEmail author
  • Yoshiro Saikawa
  • Takashi Oyama
  • Soji Ozawa
  • Koichi Suda
  • Norihito Wada
  • Tsunehiro Takahashi
  • Rieko Nakamura
  • Naoyuki Shigematsu
  • Nobutoshi Ando
  • Masaki Kitajima
  • Yuko Kitagawa



Salvage esophagectomy is potentially the only treatment available that can offer a chance of long-term survival when definitive chemoradiotherapy (CRT) fails to achieve local control for patients with esophageal squamous cell carcinoma (ESCC). However, salvage esophagectomy is a highly invasive procedure with various postoperative complications compared to planned esophagectomy after neoadjuvant chemoradiotherapy (CRT). We hypothesize that severe postoperative complications may affect not only surgical mortality but also tumor recurrence and long-term survival for patients with salvage esophagectomy after definitive CRT.


For the present study we reviewed the surgical procedures, postoperative complications, and the prognosis of 65 consecutive patients with thoracic ESCC who underwent the esophagectomy after neoadjuvant (neoadjuvant group: n = 40) or definitive (salvage group: n = 25) CRT.


Most patients underwent right-transthoracic extended esophagectomy and reconstruction using gastric conduit by way of subcutaneous route with left cervical anastomosis. The incidence of postoperative pneumonia was found to be higher in the salvage group than in the neoadjuvant group. In both groups, the survival of patients with R0 resection was significantly better than those with R1/R2 resection. Moreover, in the salvage group, the postoperative survival rate of patients with pneumonia or bacteremia/sepsis was significantly lower than that for patients who did not suffer the same complications. In the neoadjuvant group, R0 resection was selected to be the only independent prognostic factor in univariate and multivariate analysis. In contrast, in the salvage group, R0 resection and bacteremia/sepsis remained significant and were independent of the other factors in multivariate analysis.


This study reveals that postoperative morbidity affects not only the perioperative mortality but also the long-term survival of patients with ESCC who undergo salvage esophagectomy after definitive CRT.


Esophageal Cancer Esophageal Squamous Cell Carcinoma Systemic Inflammatory Response Syndrome Gastric Conduit Postoperative Infectious Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors are indebted to Andy N. Tran, MS-III of Ross University School of Medicine (North Brunswick, NJ) for his review of this manuscript.


  1. 1.
    Ando N, Ozawa S, Kitagawa Y et al (2000) Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg 232:225–232CrossRefPubMedGoogle Scholar
  2. 2.
    Takeuchi H, Ozawa S, Ando N et al (2003) Cell cycle regulators and the Ki-67 labeling index can predict the response to chemoradiotherapy and the survival of patients with locally advanced squamous cell carcinoma of the esophagus. Ann Surg Oncol 10:792–800CrossRefPubMedGoogle Scholar
  3. 3.
    Cooper JS, Guo MD, Herskovic A et al (1999) Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85–01). Radiation Therapy Oncology Group. JAMA 281:1623–1627CrossRefPubMedGoogle Scholar
  4. 4.
    Gardner-Thorpe J, Hardwick RH, Dwerryhouse SJ (2007) Salvage oesophagectomy after local failure of definitive chemoradiotherapy. Br J Surg 94:1059–1066CrossRefPubMedGoogle Scholar
  5. 5.
    Hironaka S, Ohtsu A, Boku N et al (2003) Nonrandomized comparison between definitive chemoradiotherapy and radical surgery in patients with T(2–3) N(any) M(0) squamous cell carcinoma of the esophagus. Int J Radiat Oncol Biol Phys 57:425–433CrossRefPubMedGoogle Scholar
  6. 6.
    Tachimori Y, Kanamori N, Uemura N et al (2009) Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg 137:49–54CrossRefPubMedGoogle Scholar
  7. 7.
    Hirai T, Yamashita Y, Mukaida H et al (1998) Poor prognosis in esophageal cancer patients with postoperative complications. Surg Today 28:576–579CrossRefPubMedGoogle Scholar
  8. 8.
    Japanese Esophageal Society (2007) Guidelines for the clinical and pathologic studies on carcinoma of the esophagus, 10th edn. Kanehara Publishing Co, TokyoGoogle Scholar
  9. 9.
    Takeuchi H, Ikeuchi S, Kawaguchi Y et al (2007) Clinical significance of perioperative immunonutrition for patients with esophageal cancer. World J Surg 31:2160–2167CrossRefPubMedGoogle Scholar
  10. 10.
    Bone RC, Balk RA, Cerra FB et al (1992) ACCP/SCCM consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101:1644–1655CrossRefPubMedGoogle Scholar
  11. 11.
    Gebski V, Burmeister B, Smithers BM et al (2007) Survival benefits from neoadjuvant chemoradiotherapy or chemotherapy in oesophageal carcinoma: a meta-analysis. Lancet Oncol 8:226–234CrossRefPubMedGoogle Scholar
  12. 12.
    Nakamura T, Hayashi K, Ota M et al (2004) Salvage esophagectomy after definitive chemotherapy and radiotherapy for advanced esophageal cancer. Am J Surg 188:261–266CrossRefPubMedGoogle Scholar
  13. 13.
    Stahl M, Stuschke M, Lehmann N et al (2005) Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol 23:2310–2317CrossRefPubMedGoogle Scholar
  14. 14.
    Bedenne L, Michel P, Bouché O et al (2007) Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD1902. J Clin Oncol 25:1160–1168CrossRefPubMedGoogle Scholar
  15. 15.
    Minski BD, Pajak TF, Ginsberg RJ et al (2002) INT0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20:1167–1174CrossRefGoogle Scholar
  16. 16.
    D’Journo X, Michelet P, Dahan L et al (2008) Indications and outcome of salvage surgery for oesophageal cancer. Eur J Cardiothorac Surg 33:1117–1123CrossRefPubMedGoogle Scholar
  17. 17.
    Lee Y, Fujita H, Yamana H, Kakegawa T (1994) Factors affecting leakage following esophageal anastomosis. Surg Today 24:24–29CrossRefPubMedGoogle Scholar
  18. 18.
    Aiko S, Yoshizumi Y, Sugiura Y et al (2001) Beneficial effects of immediate enteral nutrition after esophageal cancer surgery. Surg Today 31:971–978CrossRefPubMedGoogle Scholar
  19. 19.
    Kawabata K, Hagio T, Matsumoto S et al (2000) Delayed neutrophil elastase inhibition prevents subsequent progression of acute lung injury induced by endotoxin inhalation in hamsters. Am J Respir Crit Care Med 161:2013–2018PubMedGoogle Scholar
  20. 20.
    Suda K, Kitagawa Y, Ozawa S et al (2007) Neutrophil elastase inhibitor improves postoperative clinical courses after thoracic esophagectomy. Dis Esophagus 20:478–486CrossRefPubMedGoogle Scholar
  21. 21.
    Shimada H, Ochiai T, Okazumi S et al (2000) Clinical benefits of steroid therapy on surgical stress in patients with esophageal cancer. Surgery 128:791–798CrossRefPubMedGoogle Scholar
  22. 22.
    Sato N, Koeda K, Ikeda K et al (2002) Randomized study of the benefits of preoperative corticosteroid administration on the postoperative morbidity and cytokine response in patients undergoing surgery for esophageal cancer. Ann Surg 236:184–190CrossRefPubMedGoogle Scholar
  23. 23.
    Tsukada K, Miyazaki T, Katoh H et al (2006) Effect of perioperative steroid therapy on the postoperative course of patients with oesophageal cancer. Dig Liver Dis 38:240–244CrossRefPubMedGoogle Scholar
  24. 24.
    Raimondi AM, Guimarães HP, Amaral JL et al (2006) Perioperative glucocorticoid administration for prevention of systemic organ failure in patients undergoing esophageal resection for esophageal carcinoma. Sao Paulo Med J 124:112–115CrossRefPubMedGoogle Scholar
  25. 25.
    Tsujimoto H, Ichikura T, Ono S et al (2009) Impact of postoperative infection on long-term survival after potentially curative resection for gastric cancer. Ann Surg Oncol 16:311–318CrossRefPubMedGoogle Scholar
  26. 26.
    Dranoff G (2004) Cytokines in cancer pathogenesis and cancer therapy. Nat Rev Cancer 4:11–22CrossRefPubMedGoogle Scholar
  27. 27.
    Adib-Conquy M, Cavaillon J. (2009) Compensatory anti-inflammatory response syndrome. Thromb Haemost 101:36–47Google Scholar
  28. 28.
    Mynster T, Christensen IJ, Moesgaard F et al (2000) Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer Danish RANX05 Colorectal Cancer Study Group. Br J Surg 87:1553–1562CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  • Hiroya Takeuchi
    • 1
    Email author
  • Yoshiro Saikawa
    • 1
  • Takashi Oyama
    • 1
  • Soji Ozawa
    • 1
  • Koichi Suda
    • 1
  • Norihito Wada
    • 1
  • Tsunehiro Takahashi
    • 1
  • Rieko Nakamura
    • 1
  • Naoyuki Shigematsu
    • 2
  • Nobutoshi Ando
    • 1
  • Masaki Kitajima
    • 1
  • Yuko Kitagawa
    • 1
  1. 1.Department of SurgeryKeio University School of MedicineTokyoJapan
  2. 2.Department of RadiologyKeio University School of MedicineTokyoJapan

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