Salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer

Department of Surgery and Science, Kyushu University, Hukuoka, Fukuoka, Japan
Diseases of the Esophagus (Impact Factor: 1.78). 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.

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九州大学大学院 消化器・総合外科(第二外科)
2007年発表論文
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1
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    • "No patients left with gross or microscopic residual tumors after salvage surgery (R1/R2 resections) survived more than 24 months in any series (Chao et al., 2009; Nakamura et al., 2004; Oki et al., 2007; Swisher et al., 2002; Tachimori et al., 2009; Tomimaru et al., 2006). However, the R1/R2 resection rate has been substantially high, ranging from 15-50% (Chao et al., 2009; Nakamura et al., 2004; Oki et al., 2007; Swisher et al., 2002; Tachimori et al., 2009; Tomimaru et al., 2006), and the resection status cannot be confidently predicted before surgery or even during surgery because of the indistinct planes between tumor and fibrotic masses within the irradiated mediastinum. Therefore, FDG-PET or other imaging modalities are used to select patients who are absolutely unfit for salvage surgery. "
    Full-text · Chapter · Dec 2011
  • No preview · Article · Dec 2007 · British Journal of Surgery
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    [Show abstract] [Hide abstract] ABSTRACT: Some patients with localised oesophageal cancer are treated with definitive chemoradiotherapy (CRT) rather than surgery. A subset of these patients experiences local failure, relapse or treatment-related complication without distant metastases, with no other curative treatment option but salvage oesophagectomy. The aim of this study was to assess the benefit/risk ratio of surgery in such context. Review of a single institution experience with 24 patients: 18 men and 6 women, with a mean age of 59 years (+/-9). Histology was squamous cell carcinoma in 18 cases and adenocarcinoma in 6. Initial stages were cIIA (n=5), cIIB (n=1) and cIII (n=18). CRT consisted of 2-6 sessions of the association 5-fluorouracil/cisplatin concomitantly with a 50-75 Gy radiation therapy. Salvage oesophagectomy was considered for the following reasons: relapse of the disease with conclusive (n=11) or inconclusive biopsies (n=7), intractable stenosis (n=3), and perforation or severe oesophagitis (n=3), at a mean delay of 74 days (14-240 days) following completion of CRT. All patients underwent a transthoracic en-bloc oesophagectomy with 2-field lymphadenectomy. Thirty-day and 90-day mortality rates were 21% and 25%, respectively. Anastomotic leakage (p=0.05), cardiac failure (p=0.05), length of stay (p=0.03) and the number of packed red blood cells (p=0.02) were more frequent in patients who received more than 55 Gy, leading to a doubled in-hospital mortality when compared to that of patients having received lower doses. A R0 resection was achieved in 21 patients (87.5%). A complete pathological response (ypT0N0) was observed in 3 patients (12.5%). Overall and disease-free 5-year survival rates were 35% and 21%, respectively. There was no long-term survivor following R1-R2 resections. Functional results were good in more than 80% of the long-term survivors. Salvage surgery is a highly invasive and morbid operation after a volume dose of radiation exceeding 55 Gy. The indication must be carefully considered, with care taken to avoid incomplete resections. Given that long-term survival with a fair quality of life can be achieved, such high-risk surgery should be considered in selected patients at an experienced centre.
    Full-text · Article · Jul 2008 · European Journal of Cardio-Thoracic Surgery
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