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Patient selection for salvage surgery after definitive chemoradiotherapy in esophageal squamous cell carcinoma

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Abstract

Purpose

With the widespread use of definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC), salvage surgery for recurrence/residual patients became prevalent. However, survival impact of salvage surgery remains obscure at present.

Methods

The updated clinical outcomes of salvage surgery were investigated to know its survival impact. Of the 155 ESCC patients who underwent dCRT between 2009 and 2016, we included 85 patients with recurrence or residual disease. The median follow-up was 65 months.

Results

Of the 85 patients with progression disease, there were 42 and 43 patients of recurrence and residual disease, respectively. Salvage surgery was performed in 27 patients after dCRT, including 15 patients who underwent salvage esophagectomy. The 5-year overall survival (OS) of salvage surgery and otherwise patients was 66.1% and 14.5%, and the patients with salvage surgery had a significantly better prognosis (p < 0.0001). In the 15 patients who underwent salvage esophagectomy, residual disease, lymph node metastasis-positive (ycN+) after dCRT, and pathological lymph node metastasis-positive (ypN+) were significantly associated with poor prognosis (p = 0.0492, p = 0.0006, p = 0.0276), and the 5-year OS rates for the ycN/ypN combinations were 90%, 33.3%, and 0% in ycN−/ypN−, ycN+/ypN−, and ycN+/ypN+ patients, respectively (p = 0.0026). In a multivariate analysis, ycN+ was an independent poor prognostic factor (HR 13.6, 95% CI 1.65–286.8, p = 0.0154).

Conclusions

Survival impact of salvage surgery after dCRT is robust, and lymph node metastasis after dCRT may help determine the indication for salvage esophagectomy.

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Author information

Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan

    Hiroki Harada, Keishi Yamashita, Takafumi Soeno, Marie Washio, Mikiko Sakuraya, Hideki Ushiku, Masahiro Niihara, Kei Hosoda & Naoki Hiki

  2. Division of Advanced Surgical Oncology, Department of Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan

    Keishi Yamashita

  3. Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan

    Chikatoshi Katada

  4. Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan

    Hiromichi Ishiyama

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  1. Hiroki Harada
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Contributions

Study conception and design: Hiroki Harada, Keishi Yamashita, Hideki Ushiku, Masahiro Niihara, Kei Hosoda, and Naoki Hiki. Acquisition of data: Hiroki Harada, Chikatoshi Katada, Hiromichi Ishiyama, Takafumi Soeno, Marie Washio, Mikiko Sakuraya, Hideki Ushiku, Masahiro Niihara, and Kei Hosoda. Analysis and interpretation of data: Hiroki Harada, Keishi Yamashita, Takafumi Soeno, and Naoki Hiki. Drafting of manuscript: Hiroki Harada, Keishi Yamashita, Chikatoshi Katada, and Hiromichi Ishiyama. Critical revision of manuscript: Hiroki Harada, Keishi Yamashita, Chikatoshi Katada, Hiromichi Ishiyama, and Naoki Hiki.

Corresponding author

Correspondence to Naoki Hiki.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. Informed consent was obtained from all individual participants included in the study.

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Harada, H., Yamashita, K., Katada, C. et al. Patient selection for salvage surgery after definitive chemoradiotherapy in esophageal squamous cell carcinoma. Langenbecks Arch Surg 405, 767–776 (2020). https://doi.org/10.1007/s00423-020-01935-7

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