Salvage esophagectomy following definitive chemoradiotherapy

Abstract

Objectives: To evaluate the outcome of salvage surgery following definitive chemoradiotherapy (CRT) for locally advanced esophageal cancer.

Methods: We reviewed patients undergoing salvage esophagectomy from August 2000 through April 2006 at the National Cancer Center Hospital East, following 5-fluorouracil and cisplatinum chemotherapy with concurrent radiotherapy over 50 Gy. Clinicopathological backgrounds, complications, and survival were analyzed.

Results: Forty-six patients (42 men, all with squamous cell carcinoma) underwent salvage surgery after full-dose concurrent chemoradiotherapy. The median age was 61 years (range, 43-72). Thirteen patients had a relapse after complete response; 26 patients partial response; 4 patients progressive disease; 3 patients NC to CRT. Salvage surgery consisted of transthoracic esophagectomy, three-field node dissection, and reconstruction with the colon or stomach with vascular restoration. Operation time ranged from 257 to 602 min. Postoperative complications were pneumonia in 5; anastmotic leakage in 10; wound infection in 3; anastomotic stenosis in 2; recurrent nerve palsy in 4; pyothorax in 2; multiple organ failure in 1; myocardial infarction in 1; trachea necrosis in 1. There were four 30-day operative deaths and three more hospital deaths. The median survival time from salvage surgery was 12 months and that from CRT was 22 months. The 3-year survival rate was 17%. Three patients are surviving more than 3 years and their diseases were pathological NO.

Conclusion: Mobidity and mortality rates were high among patients undergoing salvage esophagectomy. However, there are some long-term survivors, and highly selected patients should be indicated for salvage surgery.