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.
A Case Report of Laparoscopic Abdominal Lymphadenectomy as Salvage Surgery for Lymph Node Recurrence following Definitive Chemoradiotherapy for Esophageal Cancer
