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Comparison of Aggressive Planned Salvage Surgery Versus Neoadjuvant Chemoradiotherapy Plus Surgery for Borderline Resectable T4 Squamous Cell Carcinoma

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

Abstract

Introduction

We compare planned salvage surgery after definitive chemoradiotherapy (SALV) versus neoadjuvant chemoradiotherapy plus surgery (NCRS) for borderline resectable T4 esophageal squamous cell carcinoma.

Patients and Methods

A total of 37 patients underwent planned SALV, and 20 underwent NCRS from 2004 to 2017. The short-term outcome measures were the R0 resection rate, complications, and treatment-related mortality. The long-term outcome measures were the 5-year overall survival rate and causes of death.

Results

R0 resection rate was similar between the SALV and NCRS groups (81% versus 85%). The incidence of postoperative pneumonia (35% versus 18%) and treatment-related mortality rate (9% versus 0%) tended to be higher in the SALV. ypT grade 2–3 (65% versus 30%, p = 0.012) and Clavien–Dindo grade ≥ IIIb complications (32% versus 0%, p = 0.008) were significantly more frequent in the SALV group. The groups had similar 5-year overall survival (26% versus 27%). The causes of death in the SALV and NCRS groups were primary esophageal cancer in 35% and 55% of patients, respectively, and pulmonary-related mortality in 24% and 5%, respectively. Multivariable Cox regression analysis revealed the following significant poor prognostic factors: stable disease as the clinical response, preoperative body mass index (BMI) of < 18.5 kg/m2, ypN stage 1–3, and R1–2 resection.

Conclusions

SALV was associated with a higher incidence of late pulmonary-related mortality but had a stronger antitumor effect than NCRS. Consequently, the survival rate was similar between the groups. Surgery is recommended for patients with a partial response and preoperative BMI of ≥ 18.5 kg/m2.

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Acknowledegment

We thank Angela Morben, DVM, ELS, from Edanz Group, for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan

    Osamu Shiraishi MD, PhD, Takushi Yasuda MD, PhD, Hiroaki Kato MD, PhD, Kota Momose MD, PhD, Yoko Hiraki MD, PhD, Atsushi Yasuda MD, PhD, Masayuki Shinkai MD, PhD, Yutaka Kimura MD, PhD & Motohiro Imano MD, PhD

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  1. Osamu Shiraishi MD, PhD
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  2. Takushi Yasuda MD, PhD
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  3. Hiroaki Kato MD, PhD
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  4. Kota Momose MD, PhD
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  5. Yoko Hiraki MD, PhD
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  6. Atsushi Yasuda MD, PhD
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  7. Masayuki Shinkai MD, PhD
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  8. Yutaka Kimura MD, PhD
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  9. Motohiro Imano MD, PhD
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Correspondence to Osamu Shiraishi MD, PhD.

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Disclosure

Osamu Shiraishi, Hiroaki Kato, Kota Momose, Yoko Hiraki, Atsushi Yasuda, Masayuki Shinkai, Yutaka Kimura, Motohiro Imano, and Takushi Yasuda have no conflicts of interest or financial ties to disclose. No funding was received for this study.

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Shiraishi, O., Yasuda, T., Kato, H. et al. Comparison of Aggressive Planned Salvage Surgery Versus Neoadjuvant Chemoradiotherapy Plus Surgery for Borderline Resectable T4 Squamous Cell Carcinoma. Ann Surg Oncol 28, 6366–6375 (2021). https://doi.org/10.1245/s10434-021-09875-2

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  • DOI: https://doi.org/10.1245/s10434-021-09875-2

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