Salvage esophagectomy: safe therapeutic strategy?

Area of Science:

• Oncology
• Surgical Gastroenterology
• Clinical Outcomes Research

Background:

• Esophageal cancer management often involves chemoradiotherapy and surgery.
• Treatment strategies include definitive chemoradiotherapy with salvage surgery or neoadjuvant chemoradiotherapy followed by planned esophagectomy.
• Comparing outcomes between these approaches is crucial for optimizing patient care.

Purpose of the Study:

• To compare short- and long-term clinical outcomes of salvage esophagectomy versus neoadjuvant chemoradiotherapy followed by planned esophagectomy (NCRS) for esophageal cancer.
• To evaluate overall survival, postoperative mortality, complications, and resection margin status.
• To identify specific risks associated with salvage esophagectomy.

Main Methods:

• A systematic review and pooled analysis of published literature.
• Inclusion of eleven studies involving 1,906 patients (563 in salvage group, 1,343 in NCRS group).
• Statistical analysis of overall survival, postoperative mortality, pulmonary complications, positive resection margins, postoperative morbidity, and anastomotic leak.

Main Results:

• No significant difference in overall survival, postoperative mortality, pulmonary complications, or positive resection margins between salvage and NCRS groups.
• Increased postoperative morbidity (P=0.046) and anastomotic leak (P<0.001) were observed in the salvage esophagectomy group.
• Salvage esophagectomy demonstrated similar short- and long-term mortality compared to NCRS.

Conclusions:

• Salvage esophagectomy offers comparable short- and long-term mortality to NCRS for esophageal cancer.
• Higher rates of anastomotic leak and postoperative morbidity necessitate careful patient selection for salvage esophagectomy.
• This approach should be reserved for high-volume surgeons in high-volume centers due to increased complication risks.