Salvage esophagectomy following definitive chemoradiotherapy

To evaluate the outcome of salvage surgery following definitive chemoradiotherapy (CRT) for locally advanced esophageal cancer.

We reviewed patients undergoing salvage esophagectomy from August 2000 through April 2006 at the National Cancer Center Hospital East, following 5-fluorouracil and cisplatinum chemotherapy with concurrent radiotherapy over 50 Gy. Clinicopathological backgrounds, complications, and survival were analyzed.

Forty-six patients (42 men, all with squamous cell carcinoma) underwent salvage surgery after full-dose concurrent chemoradiotherapy. The median age was 61 years (range, 43-72). Thirteen patients had a relapse after complete response; 26 patients partial response; 4 patients progressive disease; 3 patients NC to CRT. Salvage surgery consisted of transthoracic esophagectomy, three-field node dissection, and reconstruction with the colon or stomach with vascular restoration. Operation time ranged from 257 to 602 min. Postoperative complications were pneumonia in 5; anastmotic leakage in 10; wound infection in 3; anastomotic stenosis in 2; recurrent nerve palsy in 4; pyothorax in 2; multiple organ failure in 1; myocardial infarction in 1; trachea necrosis in 1. There were four 30-day operative deaths and three more hospital deaths. The median survival time from salvage surgery was 12 months and that from CRT was 22 months. The 3-year survival rate was 17%. Three patients are surviving more than 3 years and their diseases were pathological NO.

Mobidity and mortality rates were high among patients undergoing salvage esophagectomy. However, there are some long-term survivors, and highly selected patients should be indicated for salvage surgery.