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

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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.

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References

  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 232:225–232

    Article  CAS  PubMed  Google Scholar 

  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 10:792–800

    Article  PubMed  Google Scholar 

  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 281:1623–1627

    Article  CAS  PubMed  Google Scholar 

  4. Gardner-Thorpe J, Hardwick RH, Dwerryhouse SJ (2007) Salvage oesophagectomy after local failure of definitive chemoradiotherapy. Br J Surg 94:1059–1066

    Article  CAS  PubMed  Google Scholar 

  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 57:425–433

    Article  PubMed  Google Scholar 

  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 137:49–54

    Article  PubMed  Google Scholar 

  7. Hirai T, Yamashita Y, Mukaida H et al (1998) Poor prognosis in esophageal cancer patients with postoperative complications. Surg Today 28:576–579

    Article  CAS  PubMed  Google Scholar 

  8. Japanese Esophageal Society (2007) Guidelines for the clinical and pathologic studies on carcinoma of the esophagus, 10th edn. Kanehara Publishing Co, Tokyo

    Google Scholar 

  9. Takeuchi H, Ikeuchi S, Kawaguchi Y et al (2007) Clinical significance of perioperative immunonutrition for patients with esophageal cancer. World J Surg 31:2160–2167

    Article  PubMed  Google Scholar 

  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 101:1644–1655

    Article  CAS  PubMed  Google Scholar 

  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 8:226–234

    Article  CAS  PubMed  Google Scholar 

  12. Nakamura T, Hayashi K, Ota M et al (2004) Salvage esophagectomy after definitive chemotherapy and radiotherapy for advanced esophageal cancer. Am J Surg 188:261–266

    Article  PubMed  Google Scholar 

  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 23:2310–2317

    Article  PubMed  Google Scholar 

  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 25:1160–1168

    Article  CAS  PubMed  Google Scholar 

  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 20:1167–1174

    Article  Google Scholar 

  16. D’Journo X, Michelet P, Dahan L et al (2008) Indications and outcome of salvage surgery for oesophageal cancer. Eur J Cardiothorac Surg 33:1117–1123

    Article  PubMed  Google Scholar 

  17. Lee Y, Fujita H, Yamana H, Kakegawa T (1994) Factors affecting leakage following esophageal anastomosis. Surg Today 24:24–29

    Article  CAS  PubMed  Google Scholar 

  18. Aiko S, Yoshizumi Y, Sugiura Y et al (2001) Beneficial effects of immediate enteral nutrition after esophageal cancer surgery. Surg Today 31:971–978

    Article  CAS  PubMed  Google Scholar 

  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 161:2013–2018

    CAS  PubMed  Google Scholar 

  20. Suda K, Kitagawa Y, Ozawa S et al (2007) Neutrophil elastase inhibitor improves postoperative clinical courses after thoracic esophagectomy. Dis Esophagus 20:478–486

    Article  CAS  PubMed  Google Scholar 

  21. Shimada H, Ochiai T, Okazumi S et al (2000) Clinical benefits of steroid therapy on surgical stress in patients with esophageal cancer. Surgery 128:791–798

    Article  CAS  PubMed  Google Scholar 

  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 236:184–190

    Article  PubMed  Google Scholar 

  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 38:240–244

    Article  CAS  PubMed  Google Scholar 

  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 124:112–115

    Article  PubMed  Google Scholar 

  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 16:311–318

    Article  PubMed  Google Scholar 

  26. Dranoff G (2004) Cytokines in cancer pathogenesis and cancer therapy. Nat Rev Cancer 4:11–22

    Article  CAS  PubMed  Google Scholar 

  27. Adib-Conquy M, Cavaillon J. (2009) Compensatory anti-inflammatory response syndrome. Thromb Haemost 101:36–47

    Google Scholar 

  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 87:1553–1562

    Article  CAS  PubMed  Google Scholar 

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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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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Hiroya Takeuchi, Yoshiro Saikawa, Takashi Oyama, Soji Ozawa, Koichi Suda, Norihito Wada, Tsunehiro Takahashi, Rieko Nakamura, Nobutoshi Ando, Masaki Kitajima & Yuko Kitagawa

  2. Department of Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Naoyuki Shigematsu

Authors
  1. Hiroya Takeuchi
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  2. Yoshiro Saikawa
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  3. Takashi Oyama
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  4. Soji Ozawa
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  5. Koichi Suda
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  6. Norihito Wada
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  9. Naoyuki Shigematsu
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  10. Nobutoshi Ando
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  11. Masaki Kitajima
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  12. Yuko Kitagawa
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Correspondence to Hiroya Takeuchi.

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Takeuchi, H., Saikawa, Y., Oyama, T. et al. Factors Influencing the Long-Term Survival in Patients with Esophageal Cancer Who Underwent Esophagectomy After Chemoradiotherapy. World J Surg 34, 277–284 (2010). https://doi.org/10.1007/s00268-009-0331-9

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  • DOI: https://doi.org/10.1007/s00268-009-0331-9

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