Factors affecting the prognosis of patients with esophageal cancer undergoing salvage surgery after definitive chemoradiotherapy

Tomimaru, Yoshito; Yano, Masahiko; Takachi, Ko; Miyashiro, Isao; Ishihara, Ryu; Nishiyama, Kinji; Sasaki, Yo; Ishikawa, Osamu; Doki, Yuichiro; Imaoka, Shingi

doi:10.1002/jso.20475

Cited by 89 publications

(82 citation statements)

References 12 publications

(13 reference statements)

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“…Eleven studies were identified in the initial literature search to meet inclusion criteria ( Figure 1) (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). After screening, one further publication (23), was excluded as this institution published their outcomes in a follow-up publication, which was included in the analysis (16).…”

Section: Study and Patient Demographicsmentioning

confidence: 99%

“…After screening, one further publication (23), was excluded as this institution published their outcomes in a follow-up publication, which was included in the analysis (16). Therefore, ten comparative studies were included in this pooled final analysis (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). In total 1,906 patients were included, 563 in the salvage group and 1,343 in the NCRS group.…”

Section: Study and Patient Demographicsmentioning

confidence: 99%

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Salvage esophagectomy: safe therapeutic strategy?

Jamel¹,

Markar²

2017

J. Thorac. Dis.

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The objectives of this review were to assess both the short-and long-term clinical outcomes in patients managed with definitive chemoradiotherapy, and salvage esophagectomy subsequently in comparison to those neoadjuvant chemoradiotherapy followed by planned esophagectomy (NCRS) for esophageal cancer from published literature. Eleven studies comprising 1,906 patients were included, 563 in the salvage group and 1,343 in the NCRS group. Pooled analysis showed no significant difference between salvage and NCRS groups in overall survival [hazard ratio (HR) =1.17; 95% confidence interval (95% CI), CI, 1.41-2.51, P<0.001). Herein we found that salvage esophagectomy has similar short-and long-term mortality in comparison to planned esophagectomy following neoadjuvant chemoradiotherapy. However, anastomotic leak is increased following salvage esophagectomy suggesting the need for this practice to be reserved for high volume surgeons within high volume centers.

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Section: Study and Patient Demographicsmentioning

confidence: 99%

Section: Study and Patient Demographicsmentioning

confidence: 99%

Salvage esophagectomy: safe therapeutic strategy?

Jamel¹,

Markar²

2017

J. Thorac. Dis.

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“…To solve these drawbacks, recent research has focused on the gene expression that can predict CRTx response (Eschrich et al, 2009;He et al, 2009;Maher et al, 2009). Second, multivariate analysis revealed that the most significant factor associated with longterm survival was a R0 resection (Chao et al, 2009;Tomimaru et al, 2006). 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).…”

Section: Definitive Crtx For Resectable Ecmentioning

confidence: 96%

“…However, salvage surgery is a highly invasive and complex treatment leading to increased morbidity (50-79%) and in-hospital mortality (7-22%) as compared with those after neoadjuvant CRTx, due to the adverse events of predominantly respiratory complications and anastomotic leakage (Chao et al, 2009;Nakamura et al, 2004;M. Nishimura et al, 2007;Oki et al, 2007;Smithers et al, 2007;Swisher et al, 2002;Tachimori et al, 2009;Tomimaru et al, 2006). These hospital mortality rates are obviously higher than those for esophagectomy in Japan reported from specialized centers (2%) (Tachimori et al, 2009) or the nationwide registry (5%) (The Japan Esophageal Society).…”

Section: Definitive Crtx For Resectable Ecmentioning

confidence: 99%

“…Second, multivariate analysis revealed that the most significant factor associated with longterm survival was a R0 resection (Chao et al, 2009;Tomimaru et al, 2006). 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.…”

Section: Definitive Crtx For Resectable Ecmentioning

confidence: 99%

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Multimodal Therapies for Upper Gastrointestinal Cancers – Past, Now, and Future

Shimoyama¹

2011

Current Cancer Treatment - Novel Beyond Conventional Approaches

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Advantageous factors of R0 curative conversion esophagectomy and the optimal extent of lymphadenectomy after induction therapy for cT4b thoracic esophageal cancer

Ohkura

Ueno

Udagawa

2020

Annals of Gastroent Surgery

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Aim This study aimed to clarify the prognostic factors, the advantageous factors of R0 curative resection, and optimal extents of lymph node dissection for conversion esophagectomy after induction therapy. Methods Among 1903 patients with esophageal cancer at Toranomon Hospital between January 2006 to May 2020, 151 patients with locally advanced T4b thoracic esophageal cancer were divided into two groups according to treatment: conversion surgery group (n = 54) and non‐surgical treatment group (n = 97) for comparison. Results The patients who underwent R0 curative resection showed preferable survival comparable to the survival rate of patients with cCR in the non‐surgical treatment group (1‐, 3‐ and 5‐year survival: 96.9%, 82.1% and 76.7% vs 94.1%, 86.3%, and 86.3%; P = 0.770). Multivariate analysis revealed that the T4b tumor invasion by primary site (odds ratio (OR) = 6.100; 95% CI, 1.439‐25.865: P = 0.014) and time to conversion surgery from start of induction therapy within four months (OR = 5.229; 95% CI, 1.296‐21.102: P = 0.020) were all independent advantageous factors of R0 curative resection. Actuarial 1‐, 3‐ and 5‐year survival rates in patients who underwent conversion surgery with D2‐3 lymphadenectomy were 90.9%, 48.6%, and 40.8%, respectively. Conclusions R0 resection led to improved prognosis in conversion esophagectomy for cT4b esophageal cancer. The T4b tumor invasion by primary site and time to conversion surgery from start of induction therapy within 4 months were independent advantageous factors of R0 curative resection. In addition, standard radical esophagectomy including prophylactic D2‐/3‐ lymphadenectomy should be performed if it is possible, while taking adequate care regarding the increased risk after induction therapy.

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Factors affecting the prognosis of patients with esophageal cancer undergoing salvage surgery after definitive chemoradiotherapy

Abstract: Salvage surgery is a highly invasive and morbid operation, which is performed on immunocompromised hosts. The indication must be carefully considered, with care taken to avoid non-curative surgery.

Cited by 89 publications

References 12 publications

Salvage esophagectomy: safe therapeutic strategy?

Salvage esophagectomy: safe therapeutic strategy?

Multimodal Therapies for Upper Gastrointestinal Cancers – Past, Now, and Future

Advantageous factors of R0 curative conversion esophagectomy and the optimal extent of lymphadenectomy after induction therapy for cT4b thoracic esophageal cancer

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