Morbidity following salvage esophagectomy for squamous cell carcinoma: the MD Anderson experience

Abstract

SUMMARY The survival advantage associated with the addition of surgical therapy in esophageal squamous cell carcinoma (ESCC) patients who demonstrate a complete clinical response to chemoradiotherapy is unclear, and many institutions have adopted an organ-preserving strategy of selective surgery in this population. We sought to characterize our institutional experience of salvage esophagectomy (for failure of definitive bimodality therapy) and planned esophagectomy (as a component of trimodality therapy) by retrospectively analyzing patients with ESCC of the thoracic esophagus and GEJ who underwent esophagectomy following chemoradiotherapy between 2004 and 2016. Of 76 patients who met inclusion criteria, 46.1% (35) underwent salvage esophagectomy. Major postoperative complications (major cardiovascular and pulmonary events, anastomotic leak [grade ≥ 2], and 90-day mortality) were frequent and occurred in 52.6% of the cohort (planned resection: 36.6% [15/41]; salvage esophagectomy: 71.4% [25/35]). Observed rates of 30- and 90-day mortality for the entire cohort were 7.9% (planned: 7.3% [3/41]; salvage: 8.6% [3/35]) and 13.2% (planned: 9.8% [4/41]; salvage: 17.1% [6/35]), respectively. In summary, esophagectomy following chemoradiotherapy for ESCC at our institution has been associated with frequent postoperative morbidity and considerable rates of mortality in both planned and salvage settings. Although a selective approach to surgery may permit organ preservation in many patients with ESCC, these results highlight that salvage esophagectomy for failure of definitive-intent treatment of ESCC may also constitute a difficult clinical undertaking in some cases.

Clinical Practice of Photodynamic Therapy Using Talaporfin Sodium for Esophageal Cancer

“…ER, including ESD, is generally indicated for lesions within T1a in depth without ulceration or severe fibrosis; therefore, the indication of ER is limited and must be judged based on the operator's skill. While salvage surgery is the most invasive treatment method for patients with local failure after CRT for esophageal cancer, it can be a curative intent treatment when complete resection is achieved without any fetal complications [20,21]. Therefore, a patient's physical tolerability for surgery should be discussed with surgeons at the conference, presenting the advantages and disadvantages of salvage surgery for patients.…”

Salvage treatment after definitive chemoradiotherapy for esophageal squamous cell carcinoma

“…47 R0 resection was performed in 42.4%-86.9% of cases. [18][19][20][21][22][23][24][25][26][27][28][29][33][34][35][36][37][38][39][40][41]44,46 One-year, 3-year, and 5-year OS rates were 45.7%-84%, 18,27,34,[36][37][38]40,46 29.8%-63%, 18,[26][27][28]34,38,40,46 and 5.7%-51.6%, 18,26,27,[34][35][36][37]46 respectively. Multivariate analysis revealed the following independent prognostic factors: R0 resection, 21,[23][24]…”

Recent advances in treating oesophageal cancer

“…However, in the JCOG0502 trial, salvage esophagectomy was performed in 21 of 159 patients (13.2%) in the chemoradiation group, and it should be noted that morbidity following salvage esophagectomy is high. A retrospective review from our institution showed that major postoperative complications after salvage esophagectomy frequently occurred in 71.4% 62 . The JCOG1406-A trial compared two Japanese trials conducted in the same era: JCOG9906, which evaluated definitive chemoradiation, and JCOG9907, which evaluated preoperative chemotherapy followed by esophagectomy for clinical stage II/III ESCC 63 .…”