Abstract
Abstract Background Although the incidence of postoperative complications is higher than typical surgery, salvage esophagectomy for esophageal squmous cell cancer(ESCC) is expected to achieve good prognosis when it resutles in R0 resection. At our hospital, definitive chemo radiotherapy(dCRT) consists of irradiation(50.4 Gy/28 Fr) with concurrent chemotherapy(Nedaplatin/TS-1, or 5FU continuous administration). Salvage surgery is performed 4 weeks after the end of dCRT in case of residual disease. Methods Among 55 patients of salvage surgery after dCRT in our hospital between 2006 and 2016, 47 patients underwent salvage esophagectomy. These cases are retrospectively reviewed in terms of factors related to short and long term outcome and survival. Results The clinical T factor was 4/2/116/25 in cT1/T2/T3/T4 respectively. Clinical evaluation after dCRT was non-CR/SD in 18 cases(38%), SD in 14 (30%), PDin 2(4.3%) and recurrence after CR in 13(28%). R0 resection rate was 75%. Postoperative complications occurred in 64%. The incidence of complications exceeding Clavien-Dindo class Grade3 were 45% and all in-hospital mortality was 8.5% (4 cases). Pathological therapeutic effects were Grade1a (30%) in 14 cases and Grade3 (32%) in 15. Pathologic lymphnode metastasis was detected in 4 cases among these 15. The median overall survival (OS) time was 20.3 months and 3 year and 5 year OS rate were 39 and 22% respectively. Univariate analysis showed R1/2 cases, clinically positive lymphnode metastasis after dCRT, and pathological Grade 0/1/2 and pT3/4 was risk factors for overall survival rate. In multivariate analysis, R1/2 resected cases (HR 7.38, 95% CI 2.42–24.6, P < 0.01) were independent risk factor. Conclusion It is necessary to reduce the surgical insult of salvage esophagectomy with minimal invasive procedure and postoperative treatment. Salvage esophagectomy is highly recommended as long as it achieves R0 resection resulting in good prognosis. Disclosure All authors have declared no conflicts of interest.
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