Salvage esophagectomy for unresectable locally advanced esophageal squamous cell carcinoma: Significant or not?

We reviewed the current status and perspectives on salvage esophagectomy for initially unresectable locally advanced esophageal squamous cell carcinoma (ESCC) in the era of minimally invasive surgery and immunotherapy. Although the standard treatment for these patients is definitive chemoradiotherapy (CRT), the complete response rate to CRT alone remains unsatisfactory. Salvage esophagectomy, which is defined as surgery for residual or recurrent lesions after definitive CRT, is considered a curative treatment in clinical practice. No randomized trials have been conducted comparing salvage esophagectomy and non-surgical treatment in this cohort, because, in addition to the small number of eligible patients, constructing an appropriate study design may have been difficult. Therefore, in this review, the assessment of the current status was based on the results of several available retrospective studies. Most results from these studies show favorable results for salvage esophagectomy in this subject; however, whether it is a widely used treatment should be carefully evaluated because all these reports are limited to those from high-volume facilities for esophageal surgery. Appropriate patient selection and skilled surgical techniques are essential for successful salvage esophagectomy for initially unresectable locally advanced ESCC. To improve the short- and long-term outcomes of this surgery, advances in surgical techniques as well as further development of diagnostic capabilities, perioperative management, and multidisciplinary treatment are desirable.