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

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

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.

Notes

Acknowledgments

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.

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Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  • Hiroya Takeuchi
    • 1
  • 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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