Clinical significance of salvage esophagectomy for remnant or recurrent cancer following definitive chemoradiotherapy
- 462 Downloads
The purpose of this study was to clarify the effect of preoperative chemoradiotherapy (CRT) for esophageal cancer on the postoperative course, and to determine the clinical significance of salvage esophagectomy after definitive CRT.
Based on their preoperative treatment, 477 patients with esophageal cancer were classified into three groups: 253 patients who received surgery alone (Group I), 197 who received planned CRT (30–45 Gy, Group II), and 27 who received a salvage esophagectomy (radiation ≥60 Gy, Group III).
Postoperative complications developed in 25, 40, and 59% of the patients in Groups I, II, and III, respectively, with pulmonary complications developing in 10, 15, and 30%, and anastomotic leakage developing in 13, 23, and 37%, respectively. Mortality rates were 2.4, 2.0, and 7.4%, respectively. Multivariate analysis revealed preoperative therapy to be an independent factor associated with postoperative risks: the odds ratios (ORs) of Groups II and III compared to Group I were 1.8 and 4.0 for pulmonary complications, while they were 1.9 and 2.8, respectively, for anastomotic leakage. No critical complications developed in the 14 patients who received salvage surgery performed with strict surgical indications after 2005. The survival of Group III was not significantly different from that of Groups I and II. Most patients who received an R1/R2 resection after definitive CRT died within 2 years after salvage surgery.
Preoperative CRT is associated with postoperative complications especially in patients with R2 resection, while long-term survival can be achieved after R0 resections. Salvage surgery should be considered for carefully selected patients in whom R0 resection can be achieved.
KeywordsEsophageal cancer Salvage esophagectomy Definitive chemoradiotherapy
We thank Brian Quinn for assisting with the preparation of the manuscript. This work was supported in part by a Grant-in-Aid from the Ministry of Education, Culture, Sport, Science and Technology of Japan.
Conflict of interest
The authors declare that they have no conflict of interest.
- 15.Morita M, Nakanoko T, Kubo N, Fujinaka Y, Ikeda K, Egashira A, et al. Two-stage operation for high-risk patients with thoracic esophageal cancer: an old operation revisited. Ann Surg Oncol. doi: 10.1245/s10434-011-1654-y (On line 2011, March 16).
- 17.Japan Esophageal Society. Japanese classification of esophageal cancer. 10th ed. Tokyo: Kanehara; 2008.Google Scholar
- 18.UICC. TNM classification of malignant tumors. 7th ed. New York: Wiley; 2009.Google Scholar