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
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.


Available from: Eiji Oki
九州大学大学院 消化器・総合外科(第二外科)
消化管   page1
Salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer.
Oki E., Morita M., Kakeji Y., Ikebe M.,Sadanaga N., Egashira A.,Nishida K., Koga T.,Ohta M., Honbo T.,Yamamoto M., Baba H., Maehara
Diseases of the Esophagus 20(4):301-304,2007
p53 gene mutations in esophageal squamous cell carcinoma and their relevance to etiology and pathogenesis: Results in Japan and
comparisons with other countries.
Egashira A., Morita M.,Kakeji Y., Sadanaga N., Oki E., Honbo T., Ohta M., Maehara Y.
Cance Sci 98:1152-1156,2007
Expression of p53 and p21 and the clinical response for hyperthermochemoradiotherapy in patients with squamous cell carcinoma of the
Ishida M., Morita M.,Saeki H., Ohga T., Sadanaga N.,Watanabe M.,Kakeji Y., Maehara Y.
Anticancer Research 27:3501-3506,2007
Promoter hypermethylation and quantitative expression analysis of CDKN2A (p14ARF and p16INK4a) gene in esophageal squamous cell
Ito S., Ohga T., Saeki H., Watanabe M.,Kakeji Y., Morita M.,Yamada T., Maehara Y.
Anticancer Research 27:3345-3354,2007
Clinical significance of cytokeratin positive cells in bone marrow of gastric cancer patients.
Oki E., Kakeji Y., Baba H., Nishida K.,Koga T., Tokunaga E., Egashira A., Ikeda K., Yoshida R., Yamamoto M., Morita M., Maehara Y.
J Cancer Res Clin Oncol 133(12):995-1000,2007
Pharmacokinetics of gamma-hydroxybutylic acid (GHB)and gamma-butyrolactone(GBL),the anti-angiogenic metabolites of oral
fluoropyrimidine UFT,in patients with gastric cancer.
Emi Y.,Sumiyoshi Y.,Oki E,Kakeji Y.,FukuiY.,Maehara Y.
Fukuoka Acta Medica 98:418-424,2007
Superior mesenteric and portal vein thrombosis caused by congential antithrombin III deficiency: Report of a Case.
Shibahara k., Orita H., Yonemura H., Kohno H.
Surgery today 37:308-310,2007
Page 1
九州大学大学院 消化器・総合外科(第二外科)
消化管   page2
High-resolution fluorescent analysis of microsatellite instability in gastric cancer.
Sakurai M, Zhao Y, Oki E, Kakeji Y, Oda S, Maehara Y.
Eur J Gastroenterol Hepatol 19:701-709,2007
Prognostic significance of angiogenesis in gastrointestinal stromal tumor.
Imamura M, Yamamoto H, Nakamura N, Oda Y, Yao T, Kakeji Y, Baba H, Maehara Y, Tsuneyoshi M.
Modern Pathology 20:529-537,2007
The C-terminal tail of mitochondrial transcription factor a markedly strengthens its general binding to DNA.
Ohgaki K., Kanki T., Fukuoh A., Kurisaki H., Aoki Y., Ikeuchi M., Sang Ho Kim, Hamasaki N., Dongchon Kang.
J. Biochem 141(2):201-211,2007
Sprouty2 and Sprouty4 are essential for embryonic morphogenesis and regulation of FGF signaling.
Taniguchi K., Ayada T., Ichiyama K., Kohno R., Yonemitsu Y., Minami Y.,Kikuchi A., Maehara Y., Yoshimura A.
Biochem Biophys Res Commun 26:352(4)896-902,2007
Spreds are essential for embryonic lymphangiogenesis by regulating vascular endothelial growth factor receptor-3 signaling.
Taniguchi K., Kohno R., Ayada T., Kato R., Ichiyama K., Morisada T., Oike Y., Yonemitsu Y., Maehara Y., Yoshimura A.
Mol Cell Biol 27(12):4541-4550,2007
Clinical outcomes of FOLFOX/FOLFIRI for the Japanese patients with far advanced or recurrent colorectal cancer.
Saeki H, Higashi H, Maehara S, Tanaka J, Makino I, Imamura S, Aso M, Katoh H, Kakeji Y, Maehara Y.
Fukuoka Acta Medica 98:253-259,2007
Page 2
九州大学大学院 消化器・総合外科(第二外科)
乳腺   page3
Coexistence of the loss of heterozygosity at the PTEN locus and HER2 overexpression enhances the Akt activity thus leading to a
negative progesterone receptor expression in breast carcinoma.
Tokunaga E., Oki E., Kimura Y., Yamanaka T., Egashira A., Nishida K.,Koga T., Morita M.,Kakeji Y., Maehara Y.
Breast Cancer Res Treat 101:249-257,2007
Page 3
九州大学大学院 消化器・総合外科(第二外科)
肝臓・移植   page4
The predictors of microvascular invasion in candidates for liver transplantation with hepatocellular carcinoma-with special reference to
the serum levels of des-gamma-carboxy prothrombin.
Shirabe K., Itoh S.,Yoshizumi T., Soejima Y., Taketomi A., Aishima S., Maehara Y.
J Surg Oncol 95(3):235-240,2007
Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute's experience with 625 patients.
Taketomi A., Kitagawa D.,Ito S., Harimoto N., Yamashita Y., Gion T.,Shirabe K., Shimada M., Maehara Y.
J Am Coll Surg 204(4):580-587,2007
Extended indication for living donor liver transplantation in patients with hepatocellular carcinoma.
Soejima Y., Taketomi A., Yoshizumi T., Uchiyama H., Aishima S., Terashi T.,Shimada M., Maehara Y.
Transplantation 83:893-899,2007
Hepatitis B vaccination after living donor liver transplantation.
Soejima Y., Ikegami T.,Taketomi A., Yoshizumi T., Uchiyama H., Harada N., Yamashita Y., Maehara Y.
Liver International 27:977-982,2007
Successful living donor liver transplantation using a graft from a hepatitis B surface antigen-positive donor.
Soejima Y., Shimada M., Taketomi A., Yoshizumi T., Uchiyama H., Ikegami T., Nakamuta M., Maehara Y.
Liver International 27:1282-1286
Successful pylorus-preserving pancreaticoduodenectomy for a patient with carcinoma of the papilla vater two years after living donor
liver transplantation.
Yoshizumi T., Shimada M.,Soejima Y., Terashi T., Taketomi A., Maehara Y.
Hepato-gastroenterology 54:941-943,2007
Hepatic artery aneurysm arising from an interposition vein graft four years after auxiliary partial orthotopic liver transplantation.
Uchiyama H., Soejima Y., Taketomi A., Yoshizumi T.,Harada N., Ijichi H., Yonemura Y., Maehara Y.
Transpl Int 20(2):197-200,2007
Page 4
九州大学大学院 消化器・総合外科(第二外科)
肝臓・移植   page5
Down-regulation of aquaporin-1 in intrahepatic cholangiocarcinoma is related to tumor progression and mucin expression.
Aishima S., Kuroda Y., Nishihara Y., Taguchi K.,Iguchi T., Taketomi A., Maehara Y., Tsuneyoshi M.
Hum Pathol 38(12):1819-1825,2007
Histologic characteristics and prognostic significance in small hepatocellular carcinoma with biliary differentiation: subdivision and
comparison with ordinary hepatocellular carcinoma.
Aishima S., Nishihara Y., Kuroda Y., Taguchi K.,Iguchi T., Taketomi A., Maehara Y., Tsuneyoshi M.
Am J Surg Pathol 31(5):783-791,2007
Proposal of progression model for intrahepatic cholangiocarcinoma: clinicopathologic differences between hilar type and peripheral type.
Aishima S., Kuroda Y., Nishihara Y., Iguchi T.,Taguchi K., Taketomi A., Maehara Y., Tsuneyoshi M.
Am J Surg Pathol 31(7):1059-1067,2007
Explanted portal vein grafts for middle hepatic vein tributaries in living-donor liver transplantation.
Ikegami T., Soejima Y., Taketomi A., Yoshizumi T.,Harada N., Uchiyama H.,Shimada M., Maehara Y.
Transplantation 84:836-841,2007
One orifice vein reconstruction in left liver plus caudate lobe grafts.
Ikegami T., Soejima Y., Taketomi A., Maehara Y.
Transplantation 84:1065,2007
Successful ABO incompatible living donor liver transplantation in a patient with high isoagglutinin titer using high-dose intravenous
Ikegami T., Taketomi A., Soejima Y., Iguchi T., Sanefuji K., Kayashima H., Yoshizumi T., Harada N., Maehara Y.
Transplant Proc 39:3491-3494,2007
Reduced expression of focal adhesion kinase in intrahepatic cholangiocarcinoma is associated with poor tumor differentiation.
Ohta R., Yamashita Y., Taketomi A., Kitagawa D., Kuroda Y., Itoh S., Aishima S., Maehara Y.
Oncology 71:417-422,2007
Page 5
九州大学大学院 消化器・総合外科(第二外科)
肝臓・移植   page6
Longterm Favorable Results of Limited Hepatic Resections for Patients with Hepatocellular carcinoma: 20 Years of Experience.
Yamashita Y., Taketomi A.,Itoh S., Kitagawa D.,Kayashima H., Harimoto N.,Tsujita E., Kuroda Y., Maehara Y.
J Am Coll Surg 205:1926,2007
Mucin-hypersecreting bile duct neoplasm characterized by clinicopathological resemblance to intraductal papillary mucinous neoplasm
(IPMN) of the pancreas.
Yamashita Y., Fukuzawa K.,Taketomi A., Aishima S., Yoshizumi T., Uchiyama H., Tsujita E., Harimoto N.,Harada N., Wakasugi K.,
Maehara Y.
World Journal of Surgical Oncology 5(98):17,2007
Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery.
Yamashita Y., Taketomi A., Fukuzawa K., Tsujita E., Harimoto N., Kitagawa D., Kuroda Y., Kayashima H., Wakasugi K., Maehara Y.
Am J Surg 193:454-459,2007
A true Brunner's gland adenoma.
Suda K., Hamada S.,Takahashi M., Kumashiro Y.,Yao T., Sugimachi K., Korenaga D., Takenaka K.
Endoscopy 39:37-38,2007
Clinical significance of histone deacetylase 1 expression in patients with hepatocellular carcinoma.
Rikimaru T., Taketomi A., Yamashita Y., Shirabe K., Hamatsu T., Shimada M.,Maehara Y.
Oncology 72:69-74,2007
Rho-kinase as a novel gene therapeutic target in treatment of cold ischemia/reperfusion-induced acute lethal liver injury: effect on
hepatocellular NADPH oxidase system.
Shiotani S., Shimada M., Taketomi A., Soejima Y., Yoshizumi T., Hashimoto K.,Shimokawa H., Maehara Y.
Gene Ther 14(19):1425-1433,2007
Selective hepatic vascular exclusion for the hepatic resection of HCC.
Tsujita E., Taketomi A., Kitagawa D., Itoh S.,Harimoto N., Gion T.,Kohnoe S., Maehara Y.
Hepatogastroenterology 54(74):527-530,2007
Page 6
九州大学大学院 消化器・総合外科(第二外科)
肝臓・移植   page7
Clinical usefulness of biliary scope for Pringle's maneuver in laparoscopic hepatectomy.
Maehara S., Adachi E., Shimada M., Taketomi A., Shirabe K., Tanaka S., Maeda T., Ikeda K., Higashi H., Maehara Y.
J Am Coll Surg 205(6):816-818,2007
Role of growth factor receptor-bound protein 7 in hepatocellular carcinoma.
Itoh S., Taketomi A., Tanaka S., Harimoto N., Yamashita Y., Aishima S., Maeda T., Shirabe K., Shimada M.,   Maehara Y.
Mol Cancer Res 5(7):667-673,2007
Expression of platelet-activating factor receptor:
a novel prognosticator in patients with hepatocellular carcinoma following hepatectomy.
Kitagawa D., Taketomi A., Kayashima H., Kuroda Y.,Itoh S., Yamashita Y., Maehara Y.
Oncology 72:381-387,2007
14-3-3σ negatively regulates the cell cycle, and its down-regulation is associated with poor outcome in intrahepatic cholangiocarcinoma.
Kuroda Y., Aishima S., Taketomi A., Nishihara Y., Iguchi T., Taguchi K., Maehara Y., Tsuneyoshi M.
Hum Path 38:1014-1022,2007
Successful surgical treatment of a 96-year-old patient with obturator hernia : Review of 99 Japanese cases
Maruyama S., Maeda T., Mori E., Matsukuma A., Matsuda H.
Journal of Pelvic Medicine & Surgery 13(4):207-211,2007
Page 7
九州大学大学院 消化器・総合外科(第二外科)
脾・門脈  page8
Rectovaginal fistula following double-stapling anastomosis in low anterior resection for rectal cancer.
Tsutsumi N., Yoshida Y.,Kohnoe S., Maehara Y.
Hepatogastroenterology 54:168-283,2007
Splenic hemodynamics and decreased endothelial nitric oxide synthase in the spleen of rats with liver cirrhosis.
Yamaguchi S., Kawanaka H.,Yoshida D., Maehara Y.,Hashizume M.
Life Sci 80(22):2036-2044,2007
Laparoscopic disconnection of a huge paraumbilical vein shunt for portosystemic encephalopathy.
Yamaguchi S., Kawanaka H.,Konishi K., Anegawa G.,Yoshida D., Kinjo N.,Tomikawa M., Hashizume M.,Maehara Y.
Surg Laparosc Endosc Percutan Tech 17(3):212-214,2007
Effectiveness of endoscopic surgery training for medical students using a virtual reality simulator versus a box trainer: a randomized
controlled trial.
Tanoue K., Ieiri S.,Konishi K., Yasunaga T.,Okazaki K., Yamaguchi S.,Yoshida D., Kakeji Y., Hashizume M.
Surg Endosc 22(4):985-990,2007
Abnormality of the hepatic vein waveforms in cirrhotic patients with portal hypertension and its prognostic implications.
Kawanaka H., Kinjo N.,Anegawa G., Yoshida D.,Migoh S., Konishi K.,Ohta M., Yamaguchi S., Tomikawa M., HashizumeM.,Maehara Y.
J Gastroenterol Hepatol,2007
Construct validity for eye-hand coordination skill ona virtual reality laparoscopic surgical simulator.
Yamaguchi S., Konishi K.,Yasunaga T., Yoshida D.,Kinjo N., Kobayashi K.,Ieiri S., Okazaki K., Nakashima H., Tanoue K.,Hashizume M.,
mehara Y.
Surg Endosc 21(12):2253-2257,2007
Defective endothelial nitric oxide synthase signaling is mediated by rho-kinase activation in rats with secondary biliary cirrhosis.
Anegawa G., Kawanaka H.,Yoshida D., Konishi K.,Yamaguchi S., Kinjo N.,Taketomi A., Hashizume M., Shimokawa H., Maehara Y.
Hepatology 47(3):966-977,2007
Page 8
九州大学大学院 消化器・総合外科(第二外科)
血管   page9
Angiotensin II-induced growth of vascular smooth muscle cells is associated with modulation of cell surface area and platelet-derived
growth factor receptor expression.
Kuma S., Oki E.,Onohara T., Komori K.,Maehara Y.
Clin Exp Pharmacol Physiol 34:153-160,2007
In vivo reduction of the nuclear factor-kappaB activity using synthetic cis-element decoy oligonucleotides suppresses intimal hyperplasia
in the injured carotid arteries in rabbits.
Takeuchi K., Itoh H.,Yonemitsu Y.,Matsumoto T., Kume M.,Komori K., Maehara Y.
Surg Today 37:575-583,2007
The effect of gradually graded shear stress on the morphological integrity of a HUVEC-seeded compliant small-diameter vascular graft.
Inoguchi H,Tanaka T,Maehara Y,Matsuda T.
Biomaterials 28(3):486-495,2007
Page 9
九州大学大学院 消化器・総合外科(第二外科)
肺   page10
Toxic Shock Syndrome following Thoracic Surgery for Lung Cancer: Report of a Case
Shoji F., Yoshino I.,Osoegawa A., Yano T.,Maehara Y.
Surg Today 37:587-589,2007
Phosphoglyceride crystal deposition disease originating from the myocardium.
Shoji F., Yoshino I.,Kometani T., Yamamoto H.,Maehara Y.
J Thorac Cardiovasc Surg 134(2):508-509,2007
Pulmonary leiomyosarcoma presenting as a pancoast tumor.
Shoji F., Yoshino I.,Takeshita M., Sumiyoshi S.,Sueishi K., Maehara Y.
Pathol Res Pract 203:745-758,2007
The Serum Carcinoembryonic Antigen Level is Associated with Epidermal Growth Factor Receptor Mutations in Recurrent Lung
Shoji F., Yoshino I., Yano T., Kometani T.,Ohba T., Kouso H.,Takenaka T, Miura N.,Okazaki H., Maehara Y.
Cancer 110(12):2793-2798,2007
Combined evaluation of Rad51 and ERCC1 expressions for sensitivity to platinum agents in non-small cell lung cancer.
Takenaka T., Yoshino I.,Kouso H., Ohba T.,Yohena T, Osoegawa A.,Shoji F., Maehara Y.
Int. J. Cancer 121:895-900,2007
Page 10
  • Source
    • "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
  • Source
    [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
Show more