Salvage Esophagectomy after Definitive Chemoradiotherapy for Esophageal Cancer

Satoru Matono, Toshiaki Tanaka, Yuichi Tanaka, Takeshi Nagano, Kohei Nishimura, Kazutaka Murata, Susumu Sueyoshi*, Kazuo Shirouzu and Hiromasa Fujita

Department of Surgery, Kurume University School of Medicine
Department of Surgery, Omuta City General Hospital*

Introduction: Definitive Chemoradiotherapy (CRT) for esophageal cancer has become common, raising the incidence of salvage esophagectomy for residual and recurrent tumors after definitive CRT. We investigated indications, for salvage esophagectomy based on outcome. Methods: We reviewed 18 cases of subjects with esophageal cancer who underwent salvage esophagectomy after definitive CRT with more than 50 Gy of radiation from 1986 to 2008. Results: Seven had cStage I-III (nonT4), and 11 cStage III (T4) -IVa before definitive CRT. Definitive CRT (former cStage/later cStage) resulted in responders for 6/7, non-responders for 1/4. Median duration definitive CRT to salvage esophagectomy (former cStage/later cStage) was 6/2 months. Curative surgery was underwent 2/4 (former cStage/later cStage) and palliative surgery was underwent 5/7 (former cStage/later cStage). One, 3 and 5-year survival after curative surgery was 83%, 33% and 17%. No patient survived more than one year after palliative surgery. One, 3 and 5-year survival after responders to CRT was 39%, 15% and 7%. No patient survived more than one year after non-responders. Morbidity was 94%. Postoperative severe complications occurred more after palliative surgery than after curative surgery. Hospital mortality occurred only palliative surgery. Survival was better among responders to CRT and in those undergoig curative surgery. There is no relation between cStage and survival. Conclusions: It appears to offer some survival benefit to responders to definitive CRT and to those undergoing curative surgery.

Key words
esophageal cancer, definitive chemoradiotherapy, salvage esophagectomy

Reprint requests
Satoru Matono Department of Surgery, Kurume University School of Medicine
67 Asahimachi, Kurume, 830-0011 JAPAN

Accepted
April 28, 2010

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