[Knack and Pitfalls of Salvage Esophagectomy]

Definitive chemo-radiotherapy (CRT) in locally advanced esophageal cancer is associated with a high rate of loco-regional recurrence. In this condition, salvage esophagectomy may be considered as a therapeutic option. Despite the survival benefits of this combined approach, salvage esophagectomy remains a highly invasive procedure that confers a significant rate of morbidity and mortality and can adversely affect long-term quality of life. So careful evaluation is needed before the decision of the indication for salvage surgery. In order to prevent postoperative morbidity or mortality in patients underwent salvage esophagectomy, modifications in the surgical procedures, including minification of lymph node dissection and conversion to 2-stage surgery, are needed. Especially, it was necessary to pay attention to preserve blood flow of trachea. As aspiration pneumonia is sometimes fatal in patients after salvage esophagectomy, care to avoid aspiration is needed. Respiratory care is also essential during the follow-up period as well as perioperative period in patients who underwent salvage esophagectomy. Although salvage esophagectomy is considered a high-risk surgery, if indication for surgery was appropriate, that could be the only way which could prolong survival of locally advanced esophageal cancer patients after CRT.