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. 2025 Apr;32(4):2687-2697.
doi: 10.1245/s10434-024-16490-4. Epub 2024 Dec 3.

Outcomes of Salvage Surgery for Esophageal Carcinoma: A Nationwide Cohort Study from the Dutch Upper GI Cancer Audit

Maurits R Visser  1   2 , Daan M Voeten  3   4   5 , Suzanne S Gisbertz  4   5 , Jelle P Ruurda  1 , Richard van Hillegersberg  1 , Mark I van Berge Henegouwen  6   7 ; Dutch Upper Gastrointestinal Cancer Audit (DUCA) Group
Collaborators, Affiliations

Outcomes of Salvage Surgery for Esophageal Carcinoma: A Nationwide Cohort Study from the Dutch Upper GI Cancer Audit

Maurits R Visser et al. Ann Surg Oncol. 2025 Apr.

Abstract

Background: Salvage esophagectomy is more complex and associated with higher postoperative morbidity and mortality than standard resection. This study aimed to investigate short-term outcomes and the influence of hospital volume on these outcomes of salvage surgery for esophageal cancer.

Methods: The study enrolled all patients undergoing esophagectomy for esophageal cancer registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) between 2012 and 2022. The patients were classified as salvage or non-salvage by registering surgeons. Salvage surgery is defined in the DUCA as surgery after definitive chemoradiotherapy. Postoperative mortality (30-day/in-hospital) and morbidity were compared between the salvage and non-salvage patients using multilevel logistic regression analyses. Hospital variation in the use of salvage esophagectomy was investigated using funnel plots. The influence of hospital volume (≤ 40 to > 40 cases) and salvage volume (< 6 to ≥ 6 cases) on outcomes for salvage patients were investigated. Using backward elimination, relevant baseline characteristics influencing salvage outcomes were identified.

Results: Between 2012 and 2022, 7749 patients underwent esophagectomy, 251 (3%) of whom underwent salvage resection, varying from 0 to 8% between centers. Severe complications (43% vs 28%; odds ratio [OR], 1.81; 95 % confidence interval [CI], 1.40-2.34) and 30-day/in-hospital mortality (11% vs 3%; OR, 3.65; 95% CI, 2.38-5.61) were higher after salvage surgery than after non-salvage surgery. Salvage patients treated in high-volume centers had a lower risk of 30-day/in-hospital mortality than those treated in low-volume centers (9% vs 19%; OR, 0.42; 95% CI, 0.18-0.99), with no relation between salvage volume and outcome. Male sex, older age (> 75 years), and squamous cell carcinoma were associated with worse short-term outcomes of salvage surgery.

Conclusions: Salvage surgery is associated with worse short-term outcomes than non-salvage esophagectomy. Outcomes after salvage surgery were favorable in high-volume esophagectomy centers.

Keywords: Complications; Esophageal carcinoma; Esophagectomy; Salvage esophagectomy; Surgery.

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Conflict of interest statement

Disclosure: Mark I. van Berge Henegouwen is a consultant for Mylan, Johnson & Johnson, Alesi Surgical, BBraun, Stryker, and Medtronic. Richard van Hillegersberg and Jelle P. Ruurda are proctoring surgeons for Intuitive Surgical Inc, training other surgeons in robot-assisted minimally invasive esophagectomy, and are on the advisory board of Medtronic and Olympus. The remaining authors have no conflicts of interest.

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424. https://doi.org/10.3322/caac.21492 . - DOI - PubMed
    1. Arnold M, Ferlay J, Van Berge Henegouwen MI, Soerjomataram I. Global burden of oesophageal and gastric cancer by histology and subsite in 2018. Gut. 2020;69:1564–71. https://doi.org/10.1136/gutjnl-2020-321600 . - DOI - PubMed
    1. Richtlijnendatabase. Richtlijn Oesofaguscarcinoom. 2021. Retrieved xxxx at https://richtlijnendatabase.nl/richtlijn/oesofaguscarcinoom/oesofaguscar... .
    1. Koëter M, van Putten M, Verhoeven RHA, Lemmens VEPP, Nieuwenhuijzen GAP. Definitive chemoradiation or surgery in elderly patients with potentially curable esophageal cancer in the Netherlands: a nationwide population-based study on patterns of care and survival. Acta Oncol Madr. 2018;57:1192–200. https://doi.org/10.1080/0284186X.2018.1450521 . - DOI
    1. Merkow RP, Bilimoria KY, McCarter MD, et al. Effect of histologic subtype on treatment and outcomes for esophageal cancer in the United States. Cancer. 2012;118:3268–76. https://doi.org/10.1002/cncr.26608 . - DOI - PubMed

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