Article

Salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer

Department of Surgery and Science, Kyushu University, Hukuoka, Fukuoka, Japan
Diseases of the Esophagus (Impact Factor: 2.06). 02/2007; 20(4):301-4. DOI: 10.1111/j.1442-2050.2007.00677.x
Source: PubMed

ABSTRACT Salvage esophagectomy is performed for esophageal cancer after definitive chemoradiotherapy. The clinical significance and safety of salvage surgery has not been well established. We reviewed 14 cases of salvage esophagectomy following definitive chemoradiotherapy from 1994 through 2005 and investigated complication rates and outcomes. Seven of 14 cases were completely resected with salvage surgery. Operation time and bleeding were greater in patients who experienced incomplete resection (R1/R2). Anastomosis leakage, pulmonary dysfunction and heart failure were recognized in four, two and one patients, respectively. The postoperative complications were more frequent (71.4%) in patients with incomplete resection (R1/R2) than in patients with complete resection (R0) (28.4%). Two patients with complete resection (R0) showed long-term survival. Salvage esophagectomy may be indicated when the tumor can be resected completely after definitive chemotherapy. However, all cases of T4 cancer cannot be resected completely, resulting in a high risk for complications and poor survival.

Full-text

Available from: Eiji Oki, Jun 14, 2015
2 Followers
 · 
172 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study aimed to clarify the clinical significance of surgical resection for recurrent lesions after esophagectomy for esophageal cancer. Recurrence was detected in 113 of 365 consecutive patients who underwent surgical resection for esophageal cancer, and some treatment was performed for recurrence in 100 of the 113 patients. The treatments were classified into two groups: chemotherapy and/or radiation with surgery (surgery group, n = 14) and chemotherapy and/or radiation without surgery (no surgery group, n = 86). The outcomes were retrospectively analyzed. Of the 14 patients in the surgery group, 3 underwent repeated resection. Thus, a total of 22 resections were performed for these patients. The resected organs were the lymph nodes in nine patients, the lungs in six patients, local recurrence in two patients, subcutaneous recurrence in two patients, the liver in one patient, the brain in one patient, and the parotid gland in one patient. Among the 22 recurrent cases, 20 involved solitary lesions or multiple lesions located in a small resectable region. When the two groups were compared, the surgery group showed a more favorable prognosis in terms of both survival after esophagectomy (median survival time, 103.3 vs 23.1 months; p = 0.0060) and survival after initial recurrence (92.1 vs 12.2 months; p = 0.0057). Multimodal treatment provides a significant benefit for patients with recurrence after esophagectomy for esophageal cancer. Surgical intervention should be aggressively included in the treatment strategy when the recurrent lesion is solitary or localized.
    Annals of Surgical Oncology 08/2014; 22(1). DOI:10.1245/s10434-014-3970-5 · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purposes The aim of this study was to determine the prognostic factors in salvage surgery following definitive chemoradiotherapy (dCRT) for esophageal cancer. Methods We retrospectively reviewed twenty-five patients who underwent salvage surgery from 1986 to 2011 at Kurume University Hospital. Results Esophagectomy was adopted for 20 patients, while lymphadenectomy alone without esophagectomy was adopted for the other 5 patients. Univariate analysis found that age, response to initial treatment, presence of residual tumor, pT after salvage surgery, and severe complications were each significantly correlated with overall survival after salvage surgery. The type of surgery (esophagectomy vs lymphadenectomy) and presence of residual tumor (R) were each determined to be an independent prognostic factor by the multivariate analysis. Namely, the prognosis after R0 resection was better than that after R1/2 resection (HR 18.050, p p = 0.0086). Conclusions Salvage lymphadenectomy without esophagectomy is suggested to be an option for patients having recurrent or residual lymph nodes without any other recurrence or residual tumor after dCRT for esophageal cancer.
    Esophagus 07/2014; 11(3):197-203. DOI:10.1007/s10388-014-0430-z · 0.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract The prognosis of esophageal cancer with distant metastasis is dismal. We report a 70-year-old man with esophageal cancer and multiple lung and lymph node metastases. Complete response was achieved following definitive chemoradiotherapy. Twenty-four months after the initial chemoradiotherapy, local recurrence was detected but there was no evidence of distant metastasis. Therefore, the patient underwent salvage esophagectomy. The surgery was well tolerated without any postoperative complications. The patient is still alive 48 months after the salvage surgery. Our experience suggests that salvage esophagectomy is an important component of multimodal therapy for the recurrence of esophageal cancer.
    International surgery 09/2014; 99(5):640-644. DOI:10.9738/INTSURG-D-13-00123.1 · 0.25 Impact Factor