Salvage Esophagectomy for Recurrent Tumor after Radical Chemo-Radiotherapy

Shinsuke Saisho, Akira Kurita, Kenjiro Aogi, Masahiro Ishizaki and Shigemitsu Takashima

Department of Surgery, Clinical Research, National Shikoku Cancer Center

Radical chemoradiotherapy (CRT) is being chosen increasingly to initially treat locally advanced and respectable esophageal cancer. Salvage esophagectomy for locally recurrent tumors of the esophagus without distant metastasis after CRT has also been increasing. We review our experience with 5 salvage surgeries for esophageal cancer following radical CRT. All patients were initially clinical stage III or more. Our radical CRT regimen of initial treatment was fluorouracil (5-FU) and cisplatin (CDDP), and concurrent radiotherapy (60 Gy or more), and the outcome of CRT was 1 CR and 4 PR. We used salvage esophagectomies for 3 patients with local recurrence and for 2 patients with persistent local tumors after radical CRT. Radical surgery, which was esophagectomy with 3-field lymph node dissection (transthoracic with cervical anastomosis) was done on all patients. Postoperative complications occurred in 2, but no anastomotic leakage or postoperative mortality was observed. Four remain recurrence-free and well. Our experience suggests that the outcome of salvage esophagectomy after CRT is acceptable, but further experience way be needed to clarify this.

Key words
esophageal cancer, radical chemoradiotherapy, salvage esophagectomy

Reprint requests
Shinsuke Saisho Department of Surgery, Unnan Municipal General Hospital
96-1 Iida, Daito-chou, Ohara-gun, Shimane, 699-1221 JAPAN

Accepted
March 24, 2004

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