Indication and limit of salvage esophagectomy after definitive chemotherapy and radiotherapy for esophageal cancer

The title surgery was retrospectively examined for its significance to assess its indication and limit based on authors' experience. Subjects were 137 patients with esophageal cancer (6 cases of the stage T1a, 10 T1b, 14 T2, 40 T3 and 67 T4 before treatment) who had had the definitive chemoradiotherapy (CRT) during the period Apr., 01-Mar., 07, resulting in CR (73 cases, 53%) and non-CR (64, 47%). Recurrence was observed in 41 cases out of the 73 CR, of whose 21 underwent the salvage esophagectomy (3 cases, endoscopic mucosal resection), and 16/64 of non-CR cases also received the surgery. As for prognosis of the CRT-CR cases, salvage surgery in 18 recurrent cases resulted in 2-y survival of 54.7% in contrast to 20 cases without the surgery, 38.5%. The 2-y survival of 16 cases of the CRT-non-CR after operation who having the rest tissue, was 21.0% and of 46 cases without the surgery who having additional extensive lymphatic, remote metastases and/or unresectable lesion as well, 8.9%. Overall, about half of recurrent cases of CRT-CR were of only local recurrence without lymphatic metastasis, who were thought to be indicated to the surgery. Prognosis after the operation was quite poor in CRT-non-CR cases with metastasis, due to complication and rapid relapse post surgery. Thus indication of the salvage esophagectomy after CRT should be re-evaluated, especially for patients with advanced disease. (R.T.)