Outcomes of Salvage Oesophagectomy following Definitive Chemoradiotherapy – A Systematic Review and Analysis. — ASN Events
  1. Schedule
  2. ACCG/ProbeNet Poster Presentations I - Oesophageal
  3. Outcomes of Salvage Oesophagectomy following Definitive Chemoradiotherapy – A Systematic Review and Analysis.

Outcomes of Salvage Oesophagectomy following Definitive Chemoradiotherapy – A Systematic Review and Analysis. (#312)

Lincoln Rothwell 1 , Glyn Jamieson 1
  1. University of Adelaide, Adelaide, South, Australia

INTRODUCTION: Definitive chemoradiotherapy for inoperable oesophageal cancer is associated with locoregional failure in up to 50%, and failure to respond in 25-28%1,2. Salvage oesophagectomy in this setting has long been associated with increased morbidity and mortality, but study numbers have been limited.

AIM: The aim of this systematic review was to identify if there was a difference in morbidity, mortality and survival in those undergoing Salvage oesophagectomy compared with patients undergoing neo-adjuvant treatment followed by surgery.

METHODS: Database searches for relevant articles excluding reviews and non-English articles was undertaken. Morbidity, Mortality and Survival data was extracted, pooled and analysed. Comparative neoadjuvant complication rates were taken from the analysed articles.

RESULTS: 18 articles met the inclusion criteria, totalling 498 patients that were assessed. 202 patients had Stage3 or 4 disease. Salvage oesophagectomy was associated with increased rates of anastomotic and respiratory complications but similar cardiac or wound complications. Median length of stay was 29.9d, with 30d Mortality was 5.1% with a 5 year survival of 30.0%. R0 resection was associated with a better survival compared with R1/R2.

CONCLUSION: Salvage oesophagectomy is associated with increased morbidity, but mortality and long term survival are similar to patients undergoing neo-adjuvant treatment. This has possible clinical implications on who is defined as resectable, and that Salvage surgery is a viable option for patients with oesophageal cancer recurrence or non-response, after definitive treatment.

  1. Cooper JS et al. Chemoradiotherapy of locally advanced oesophageal cancer : long term follow-up of a prospective RCT (RTOG 85-01). JAMA. 1999;281:1623-27
  2. Welsh J et al. Failure patterns in patients with esophageal cancer treated with definitive chemoradiation. Cancer. 2012 May 15;118(10):2632-40.
  3. Nakamura T et al. Induction chemoradiotherapy followed by esophagectomy for advanced squamous cell carcinoma of the esophagus. Esophagus. 2011;8:89-95
  4. Tachimori Y et al Salvage esophagectomy after high dose chemoradiotherapy for esophageal squamous cell cancer. J Thoracic and Cardiovasc Surg. 2009;137:49-54
  5. Miyata H et al Salvage esophagectomy after definitve Chemoradiotherapy for thoracic oesophageal cancer. J Surg Oncol. 2009;100:442-446
  6. Morita M et al Clinical significance of salvage eosophagectomy for reminant or recurrent cancer following definitive chemoradiotherapy J Gastroenterol. 2011;46:1284-1291
  7. Takeuchi H et al. Factors influencing the long term survival in patients with oesophageal cancer who underwent esophagectomy after chemoradiotherapy. WJS. 2010;34:277-284
  8. Pinto C et al. Salvage oesophagectomy after exclusive chemoradiotherapy: results at the Brazilian National Cancer Institute( INCA). Dis Esoph. 2009;22:682-686
  9. Piessen G et al Patients with locally advanced esophageal carcinoma nonresponder to radiochemotherapy: who will benefit from surgery.Ann Surg Oncol. 2007;14:2036-2044
  10. Murakami M, Kuroda Y, Matsusue S, Okamoto Y, Nakajima T, Nishimura S, et al. Treatment results of esophageal carcinoma of clinical T3, T4M0: historical comparison between neoadjuvant chemoradiotherapy followed by surgery or definitive radiotherapy and conventional surgery. Oncol Rep 2000; 7:571–8.
  11. Smithers BM, Cullinan M, Thomas JM, Martin I, Barbour AP, Burmeister BH, et al. Outcomes from salvage esophagectomy post definitive chemoradiotherapy compared with resection following preoperative neoadjuvant chemoradiotherapy. Dis Esophagus 2007;20:471–7.
  12. Wilson KS, Wilson AG, Dewar GJ. Curative treatment for esophageal cancer: Vancouver Island Cancer Centre experience from 1993 to 1998. Can J Gastroenterol 2002;16:361–8.
  13. Meunier B, Raoul J, Le Prise E, Lakehal M, Launois B. Salvage esophagectomy after unsuccessful curative chemoradiotherapy for squamous cell cancer of the esophagus. Dig Surg 1998;15:224–6.
  14. Swisher SG, Wynn P, Putnam JB, Mosheim MB, Correa AM, Komaki RR, et al. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg 2002;123:175–83
  15. Nakamura T, Hayashi K, Ota M, Eguchi R, Ide H, Takasaki K, et al. Salvage esophagectomy after definitive chemotherapy and radiotherapy for advanced esophageal cancer. Am J Surg 2004;188:261–6.
  16. Oki E, Morita M, Kakeji Y, Ikebe M, Sadanaga N, Egasira A, et al. Salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer. Dis Esophagus 2007;20:301–4.
  17. Nishimura M, Daiko H, Yoshida J, Nagai K. Salvage esophagectomy following definitive chemoradiotherapy. Gen Thorac Cardiovasc Surg 2007;55:461–5
  18. Chao YK, Chan SC, Chang HK, Liu YH, Wu YC, Hsieh MJ, et al. Salvage surgery after failed chemoradiotherapy in squamous cell carcinoma of the esophagus. Eur J Surg Oncol 2008;35:289-294
  19. Tomimaru Y, Yano M, Takachi K, Miyashiro I, Ishihara R, Nishiyama K et al. Factors affecting the prognosis of patients with esophageal cancer undergoing salvage surgery after definitive chemoradiotherapy. J Surg Oncol 2006; 93:422–428
  20. D’Journo X, Michelet P, Dahan L et al (2008) Indications and outcome of salvage surgery for oesophageal cancer. Eur J Cardiothorac Surg 33:1117–1123