Salvage surgery after failed chemoradiotherapy in squamous cell carcinoma of the esophagus

• Published in: European journal of surgical oncology 2009-03, Vol.35 (3), p.289-294
• Main Authors: Chao, Y.K, Chan, S.C, Chang, H.K, Liu, Y.H, Wu, Y.C, Hsieh, M.J, Tseng, C.K, Liu, H.P
• Format: Article
• Language: English
• Subjects: Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; Chi-Square Distribution; Combined Modality Therapy; Definitive chemoradiotherapy; Esophageal cancer; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - mortality; Esophageal Neoplasms - radiotherapy; Esophageal Neoplasms - surgery; Esophagectomy - methods; Female; Hematology, Oncology and Palliative Medicine; Hospital Mortality; Humans; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Proportional Hazards Models; Recurrence; Registries; Retrospective Studies; Risk Factors; Salvage surgery; Salvage Therapy; Squamous cell carcinoma; Surgery; Survival Rate; Treatment Failure; Treatment Outcome
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2008.02.014

Abstract Aims To investigate the survival benefit and preoperative risk factors for hospital mortality of salvage surgery in esophageal cancer patients who had locoregional residual/recurrent tumor after definitive chemoradiotherapy. Methods We retrospectively reviewed the esophageal cancer patients who presented at our hospital from 1997 to 2004. Forty-seven patients who had squamous cell cancer and developed locoregional recurrent/persistent disease after primary definitive chemoradiotherapy were elected. Twenty-seven of them received salvage esophagectomy (group 1) and the other 20 underwent non-operative treatment only (group 2). In order to assess the surgery-related mobility and mortality in group 1, 191 patients who received neoadjuvant chemoradiotherapy followed by operation during the same time period were also enrolled (group 3). Results The 5-year overall survival of group 1 patients was 25.4%. In contrast, all of the patients in the group 2 died within 16.7 months. The difference was statistically significant ( p = 0.0029). In comparison with group 3, group 1 patients had significantly more surgery-related complications and hospital mortality. In univariate analysis for preoperative risk factors, a low albumin or hemoglobulin level was associated with high hospital mortality in group 1 ( p = 0.004 and 0.003, respectively). After multivariate analysis, only the low albumin level remained borderline significance. As for disease specific survival after salvage surgery, R0 resection was the only independent prognosticator ( p = 0.049). Conclusion Salvage surgery provides survival benefit in esophageal cancer patients with locoregional persistent or recurrent disease after primary definitive chemoradiotherapy. Preoperative albumin and hemoglobulin levels are associated with hospital mortality and may aid in selecting suitable patient for salvage surgery.