PS01.236: MEDIASTINOSCOPIC SALVAGE ESOPHAGECTOMY FOR RECURRENT ESOPHAGEAL CANCER AFTER DEFINITIVE CHEMORADIOTHERAPY IN A PREVIOUSLY PNEUMONECTOMIZED PATIENT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 116-117
Author(s):  
Tomoyuki Okumura ◽  
Yasuyuki Seto ◽  
Susumu Aikou ◽  
Makoto Moriyama ◽  
Shinich Sekine ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Tumor Recurrence ◽  
Conflicts Of Interest ◽  
Primary Lung Cancer ◽  
Esophageal Wall ◽  
Thoracic Esophagus ◽  
Definitive Chemoradiotherapy ◽  
Transhiatal Approach ◽  
Salvage Esophagectomy ◽  
Sealing Device

Abstract Background Mediastinoscopic esophagectomy is a minimally invasive surgery for thoracic esophageal cancer avoiding one-lung ventilation or transthoracic procedure. Methods We performed for the first time in the literature, salvage esophagectomy with combination of mediastinoscopic cervical approach and laparoscopic/mediastinoscopic transhiatal approach for recurrent thoracic esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (dCRT) in a patient who had previously undergone a left pneumonectomy for primary lung cancer. Results A 66-year-old man was diagnosed as local recurrence of lower ESCC (cT3N0M0 cStage II) at 9 years after dCRT. His medical history included left-sided pneumonectomy for lung adenocarcinoma 9 years previously. Then the patient was diagnosed as lower thoracic ESCC (cT3N1M0 cStage III) at 2 months after pneumonectomy. He received dCRT consisting of CDDP/5-FU infusion and irradiation (60 Gy) and achieved complete response. No evidence of tumor recurrence was observed at endoscopic surveillance up until 6 years after dCRT. For this present surgery, a cervical wound was made and the intramediastinal procedure was performed under pneumomediastinum. After mobilization of upper/middle thoracic esophagus, the esophageal wall was safely separated from the remaining part and the stump of the left main bronchus. Dense adhesions between the esophagus and fibrotic tissue at the site of previous left mediastinal pleural resection was divided using a sealing device. In the abdomen, 5 ports were inserted to perform abdominal and transhiatal procedures under CO2 insufflation. After mobilization of the stomach, fibrotic scar tissue around the lower esophagus was divided using a sealing device and the peri-esophageal space dissected from cervical and transhiatal approach were connected to completely mobilize the thoracic esophagus. The esophagectomy was uneventfully carried out followed by reconstruction with gastric conduit via retrosternal rout. Pathological findings demonstrated a moderately differentiated ESCC (pT3-AD pN1 M0 pStage III), indicating that R0 resection was successfully performed. The patient has been closely observed as an outpatient and was alive and healthy at 3 months after the operation without tumor recurrence. Conclusion Mediastinoscopic esophagectomy is a safe and curative treatment strategy for esophageal cancer patients who had a previous pneumonectomy, even in salvage surgery for recurrent cancer after dCRT. Disclosure All authors have declared no conflicts of interest.

PS02.139: THE TREATMENT STRATEGY AND CLINICAL OUTCOMES FOR SALVAGE ESOPHAGECTOMY AFTER DEFINITIVE CHEMORADIOTHERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 160-160
Author(s):  
Kyohei Ogawa ◽  
Kosuke Narumiya ◽  
Kenji Kudo ◽  
Yosuke Yagawa ◽  
Shinsuke Maeda ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Clinical Outcomes ◽  
Treatment Strategy ◽  
Conflicts Of Interest ◽  
High Rate ◽  
Hospital Death ◽  
Definitive Chemoradiotherapy ◽  
Unresectable Tumor ◽  
Back Ground ◽  
Salvage Esophagectomy

Abstract Background Definitive chemoradiotherapy for esophageal cancer which was unresectable tumor has become common therapy. In recently, we have perform chemoradiotherapy for resectable tumor because esophagectomy for esophageal cancer is an invasive surgical procedure. But some cases were recurrent. We examined the treatment strategy and clinical outcomes of salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer. Methods We reviewed 46 cases of subjects with esophageal cancer who underwent salvage esophagectomy after definitive chemoradiotherapy with more than 50Gy of radiation from 2000 to 2017. We exam (1) Back ground (2) Term after Chemoradiotherapy (3)Surgical approach (4) Route of reconstruction (5)Rang of lymphanodectomy (6)Complication (7)Prognosis. Results Age 63.0(43–79), Male: Female = 44:2, Location: Upper/Middle/Lower = 15/25/8, T1/T2/T3/T4 = 11:2:25:8 R0: R1: R2 = 35:9:2 (2) Within1 year/More than 1 year = 31/15 (3) Neck digection/Right thoracotomy: Left thoracotomy: laparotomy = 8:31:5:2 (4) Mediastinal rute/Ante/Retro = 34:9:3 (5) 1 Field:2 Field:3 Field = 11:27:8 (6) Anastleakage/Pneumonia/Abcess/Meningitis/Fluid in the thoracic cavity = 11: 9: 4: 1: 8 (7) 5-years survival rate was 36%. Hospital death was4.3% Conclusion There were high rate complications for salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer. Patients should be carefully selected for salvage esophagectomy.Surgeons should consider the indications and techniques for esophageal surgery to increase cure rates and decrease morbidity. Disclosure All authors have declared no conflicts of interest.

scholarly journals Salvage esophagectomy for local recurrent esophageal cancer after definitive chemoradiotherapy followed by photodynamic therapy: A case report

2021 ◽  
Vol 80 ◽  
pp. 105617
Author(s):  
Wataru Hirose ◽  
Yusuke Taniyama ◽  
Fumiyoshi Fujishima ◽  
Chiaki Sato ◽  
Michiaki Unno ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Photodynamic Therapy ◽  
Case Report ◽  
Definitive Chemoradiotherapy ◽  
Salvage Esophagectomy

PS02.138: SALVAGE ESOPHAGECTOMY: SINGLE ONCOLOGICAL CENTER EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 159-160
Author(s):  
Flávio Sabino ◽  
Marco Guimaraes ◽  
Carlos Eduardo Pinto ◽  
Daniel Fernandes ◽  
Luis Felipe Pinto ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
High Volume ◽  
Published Data ◽  
Surgical Morbidity ◽  
Salvage Esophagectomy ◽  
Thoracic Approach ◽  
Clinical Conditions ◽  
Local Advanced

Abstract Background Surgical resection is considering the gold standard in esophageal cancer treatment, with 15–40% cure global rates. Radical exclusive chemoradiotherapy (CRT) is used in patients with local advanced esophageal cancer or without clinical conditions for esophagectomy, with a 5-year overall survival up to 30%. However, locoregional control is poor with a 40–60% recurrence rate and salvage esophagectomy maybe an option for these patients. Methods Our objective is to report the experience of a single high volume oncological institution with salvage esophagectomy. Retrospective analysis of 28 patients medical records, with esophageal cancer, submitted to Salvage Esophagectomy in Brazilian NCI after radical exclusive CRT or RT between January 1990 and December 2015. Results Median age was 56 years and most are male (78,5%). Esophageal middle third was the tumor principal location (50%) and histological type was squamous cell carcinoma (82%). Thoracic approach for esophagectomy was the principal surgical technique, and gastric tube the most used conduit for reconstruction (78,5%). Surgery was R0 in 83% of the cases, with a surgical morbidity of 64%. Median hospital time was 15 days (8–58) and surgical mortality 14% (4 patients), with 7% in the first 30 days. Median overall survival was 22,3 months. Conclusion Our results are in line with published data in the literature. Besides surgical morbidity and mortality, Salvage Esophagectomy remains de only chance of cure for patients with locoregional recurrence after radical exclusive CRT. Disclosure All authors have declared no conflicts of interest.

Preoperative Irradiation and Surgery for Esophageal Cancer: Causes of Failure

1980 ◽  
Vol 66 (1) ◽  
pp. 109-116 ◽  
Author(s):  
Maurizio Valente ◽  
Ignazio Cataldo ◽  
Cesare Grandi ◽  
Alberto Luini ◽  
Franco Milani ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Recurrence Rate ◽  
Esophageal Resection ◽  
Early Recurrence ◽  
Esophageal Wall ◽  
Thoracic Esophagus ◽  
Preoperative Irradiation ◽  
Historical Comparison ◽  
Nodal Diffusion ◽  
Early Recurrence Rate

Twenty-seven patients with squamous esophageal cancer underwent small-volume, low-dose, concentrated radiotherapy followed by esophageal resection whenever possible (esophagectomy for tumors of the thoracic esophagus and esophagogastrectomy for tumors of the lower esophagus). Curative resectability was 70% (19/27) with 4 operative deaths (21%). Recurrence rate was 66% after a mean period of 16 months, and the failure pathway was nodal in 53% of the cases. Historical comparison of the data suggests that preoperative irradiation increases the curative resectability rate without changing the early recurrence rate or failure pathway. Tumors with deeper invasion of the esophageal wall, which benefit by preoperative irradiation, are probably related to greater nodal diffusion, which is partly outside of the volume that may be resected or irradiated.

scholarly journals Different strategy of salvage esophagectomy between residual and recurrent esophageal cancer after definitive chemoradiotherapy

2018 ◽  
Vol 10 (3) ◽  
pp. 1554-1562 ◽  
Author(s):  
Yusuke Taniyama ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Hiroshi Okamoto ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Definitive Chemoradiotherapy ◽  
Salvage Esophagectomy

RA10.04: POSTOPERATIVE PNEUMONIA IS ASSOCIATED WITH SHORT-TERM AND LONG-TERM MORTALITY OF DEFINITIVE CHEMORADIOTHERAPY FOLLOWED BY SALVAGE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 43-43
Author(s):  
Masashi Takeuchi ◽  
Hirofumi Kawakubo ◽  
Shuhei Mayanagi ◽  
Kazumasa Fukuda ◽  
Rieko Nakamura ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Prognostic Factors ◽  
Prediction Model ◽  
Salvage Surgery ◽  
Postoperative Pneumonia ◽  
Short Term ◽  
Definitive Chemoradiotherapy ◽  
Invasive Approach ◽  
Salvage Esophagectomy

Abstract Background Although definitive chemoradiotherapy (CRT) with salvage esophagectomy has improved overall survival (OS) for esophageal cancer, it is a more invasive approach than neoadjuvant CRT followed by surgery or surgery alone, and causes high mortality after surgery. The purpose of this study was to investigate the short and long-term outcomes of salvage esophagectomy, to determine their prognostic factors, and to create a prediction model for OS using a classification and regression tree (CART). Methods Ninety patients who had undergone CRT followed by esophagectomy for thoracic esophageal cancer at Keio University Hospital, Tokyo, Japan, between June 1994 and August 2014 were identified for this study. We divided the 90 patients into two groups—the salvage group and the neoadjuvant group—according to the dose of irradiation of CRT. Forty-four patients who underwent CRT with radiation dose less than 50 Gy, followed by planned esophagectomy, were allocated to the neoadjuvant group. Forty-six patients with salvage esophagectomy for locally recurrent or residual cancer after definitive CRT (greater than 50 Gy) were allocated to the salvage group. Results Patients from the salvage group tended to have a lower OS (median survival: Salvage, 25 months vs neoadjuvant, 50 months, P = 0.149). In the salvage group, pneumonia and age were identified as factors predictive of in-hospital mortality. OS was significantly lower in patients with postoperative pneumonia and female gender. We set the prediction model for OS in the salvage group using survival CART. The group of R1/2 resection aged ≥ 56.5 years and the group suffering from postoperative pneumonia were the groups at highest risk; the area under the curve was 0.72. Conclusion The present study demonstrates the short-term and long-term prognostic factors of salvage esophagectomy after definitive CRT for esophageal cancer. Achieving improvement in OS after salvage surgery requires increased R0 resection rates and decreased pulmonary complications. Both informed decision making in the adoption of salvage surgery and specific plans to reduce pneumonia through means such as pulmonary rehabilitation are required. Disclosure All authors have declared no conflicts of interest.

PS02.003: SINGLE INCISION TRANSCERVICAL MEDIASTINOSCOPIC LYMPHADENECTOMY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 120-120
Author(s):  
Chang Hyun Kim ◽  
Jin-Jo Kim
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Old Age ◽  
Single Incision ◽  
Conflicts Of Interest ◽  
Mediastinal Lymph Node ◽  
Safe Procedure ◽  
En Bloc ◽  
Transhiatal Approach ◽  
The Mean

Abstract Background A transhiatal approach in esophageal cancer surgery has limitation for mediastinal lymph node dissection compared with thransthoracic approach for esophageal cancer. Because of insufficient lymph node clearance, single incision mediastinoscopic surgery is an one of the minimally invasive surgical option for esophageal cancer. Herein, we introduce our initial experience with use of the procedure in 3 patients with esophageal cancer Methods We retrospectively collected data from 3 patients who diagnosed with esophageal cancer and who underwent 3 field transmediastinal radical esophagectomy (TMRE) between Jun 2016 and December 2017. TMRE was performed in old age patients (> 75 years) and patients with limited cardiopulmonary reserve in whom thransthoracic approach could not be used. After the left cervical incision and cervical lymphadenectomy, a single port was inserted into the wound. Esophageal mobilization with en bloc lymphadenectomy along the left and right recurrent laryngeal nerve was then performed. Carbon dioxide insufflation expanded the intramediastinal space, and deep mediastinal structures were clearly visualized, allowing lymphadenectomy to be safely and carefully performed along the nerves. Laparoscopic transhiatal esophagectomy was then performed with en bloc lymphadenectomy for lower and/or middle mediastinal nodes. Results The mean age was 75.5 ± 3.5. Among the 3 patients, two patients had severe cardiopulmonary dysfunction. The mean operation time in transmediastinal approach and transhiatal approach were 202.0 ± 18.0 and 350.0 ± 27.8, respectively. The mean retrieval number of mediastinal lymph node was 39.0 ± 5.3. There were no severe postoperative complications and there was no postoperative mortality. Mild pleural effusion was occurred in only one patient. Conclusion TMRE with single incision mediastinoscopic approach was technically feasible and oncologically safe procedure for esophageal cancer, especially in patients with old age or with limited cardiopulmonary reserve. Disclosure All authors have declared no conflicts of interest.

PS02.039: SERUM CRP LEVEL IS A PROGNOSTIC FACTOR OF ESOPHAGEAL CANCER TREATED WITH DEFINITIVE CHEMORADIOTHERAPY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 131-131
Author(s):  
Daisuke Ishioka ◽  
Masaaki Saito ◽  
Jun Takahashi ◽  
Tamotsu Obitsu ◽  
Hirokazu Kiyozaki ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Conflicts Of Interest ◽  
Standard Dose ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Complete Response ◽  
Advanced Esophageal Cancer ◽  
Definitive Chemoradiotherapy ◽  
History Of ◽  
Serum Crp

Abstract Background In advanced esophageal cancer, definitive combined chemoradiotherapy (d-CRT) is considered to be one of standard therapy in Japan. However, there have been few studies of the correlation of clinical factors and response to chemoradiotherapy. The aim of this study is to clarify the correlation of serum CRP level and response to definitive chemoradiotherapy for advanced esophageal cancer. Methods A total of 78 patients with clinical stage II/III esophageal cancer who were treated with d-CRT at our institute from 2002 to 2014 were retrospectively reviewed. 57 patients received chemotherapy using low-dose 5-FU and cisplatin, and remaining 19 patients received chemotherapy using standard-dose 5-FU and cisplatin according to the protocol described in the RTOG trial combined with radiation therapy. The patients were stratified by response to chemoradiotherapy by two groups. 60 patients (54 patients had a complete response and 6 had a partial response) were in Responder group, and 18 patients (7 patients had a stable disease and 11 had a progressive disease) were in Non- responder group. The correlation of survival rate and serum CRP level before d-CRT was evaluated. Results At the time of analysis, the median follow-up period was 32 months (range 3–124 months). The overall survival of the Responder group was significantly better than that of Non- responder group (P < 0.001). Univariate analysis showed that white blood cell > 8000/m3 (P = 0.036), CRP > 1.0mg/dl (P = 0.002), adventitia invasion (P = 0.04) and history of the smoking (P = 0.037) were predictive for response of d-CRT. Multivariate analyses identified serum CRP level (P = 0.002) as independent prognostic factors for response of d-CRT. Conclusion Our findings suggest that serum CRP level may be a useful marker to predict a response to definitive chemoradiotherapy. However, further examinations in the future will be necessary to determine its efficacy. Disclosure All authors have declared no conflicts of interest.

PS02.031: DEFINITIVE CHEMORADIOTHERAPY WITH DOCETAXEL, CISPLATIN, AND 5-FLUOROURACIL (DCF-R) FOR ADVANCED CERVICAL ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 128-129
Author(s):  
Hiroshi Okamoto ◽  
Yusuke Taniyama ◽  
Tadashi Sakurai ◽  
Takahiro Heishi ◽  
Chiaki Sato ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Esophageal Cancer ◽  
Lymph Node ◽  
Survival Rate ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Conflicts Of Interest ◽  
Clinical Stage ◽  
Stage Ii ◽  
Definitive Chemoradiotherapy

Abstract Background Recently, definitive chemoradiotherapy (dCRT) has become one of the essential treatment strategies for esophageal squamous cell carcinoma (ESCC) and has been especially gaining prevalence for cervical ESCC to preserve the larynx. There have been recent reports on favorable outcomes of docetaxel/CDDP/5-FU (DCF-R) for advanced esophageal cancer. Our department recently introduced DCF-R for treating advanced cervical ESCC. We analyzed the safety and outcomes of DCF-R in patients with advanced cervical ESCC. Methods We retrospectively evaluated 12 advanced cervical ESCC patients (clinical stage II–IV, including T4b and/or M1 lymph node) in our department who received DCF-R as the first-line treatment between December 2010 and February 2015. Results Our patient cohort comprised 9 males and 3 females (median age, 67.5 years; range: 54–76 years). All patients were squamous cell carcinoma. The median observation period was 34.5 (8–80) months with total irradiation dose of 64.0 (60–70) Gy. The pretreatment clinical stage (according to Union for International Cancer Center) included one stage II, seven stage III, and four stage IV cases (including 3 patients with T4b [2 trachea and 1 thyroid] and 4 patients with M1 lymph node. We attained complete response (CR) in 10 patients and stable disease in 2 patients. Of 10 patients with CR, 5 experienced recurrence and 5 continued exhibiting CR. Two persistent patients included one patient who died of cancer and one patient who underwent salvage surgery. Furthermore, grade 3 or more adverse events as defined in Common Terminology Criteria for Adverse Event version 4 included leucopenia (91.7%), neutropenia (91.7%), febrile neutropenia (50%), and pharyngeal pain (50%). There was no treatment-related mortality and treatment schedules were completed in all patients, although dose reduction of the second cycle of chemotherapy was required in four patients (33%) and change in the radiation schedule was required in one patient (8.3%). While the 2-/3-/5-year overall survival rate was 66.7%/48.6%/48.6%, the 2-/3-/5-year recurrent-free survival rate was 58.3%/50.0%/37.5%, respectively. Conclusion DCF-R treatment for advanced cervical ESCC could be completed by the careful administration, and although a strong blood toxicity might occur, a favorable prognosis can be obtained with larynx preservation. Disclosure All authors have declared no conflicts of interest.

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