Factors Influencing the Long-Term Survival in Patients with Esophageal Cancer Who Underwent Esophagectomy After Chemoradiotherapy

• Published in: World journal of surgery 2010-02, Vol.34 (2), p.277-284
• Main Authors: Takeuchi, Hiroya, Saikawa, Yoshiro, Oyama, Takashi, Ozawa, Soji, Suda, Koichi, Wada, Norihito, Takahashi, Tsunehiro, Nakamura, Rieko, Shigematsu, Naoyuki, Ando, Nobutoshi, Kitajima, Masaki, Kitagawa, Yuko
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Aged; Biological and medical sciences; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - radiotherapy; Carcinoma, Squamous Cell - surgery; Cardiac Surgery; Combined Modality Therapy; Diagnostic Imaging; Esophageal Cancer; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - mortality; Esophageal Neoplasms - radiotherapy; Esophageal Neoplasms - surgery; Esophageal Squamous Cell Carcinoma; Esophagectomy - methods; Esophagus; Female; Gastric Conduit; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; General Surgery; Humans; Lymph Node Excision; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy; Postoperative Complications - epidemiology; Postoperative Infectious Complication; Prognosis; Proportional Hazards Models; Risk Factors; Salvage Therapy; Statistics, Nonparametric; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Systemic Inflammatory Response Syndrome; Thoracic Surgery; Treatment Outcome; Tumors; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-009-0331-9

Background Salvage esophagectomy is potentially the only treatment available that can offer a chance of long-term survival when definitive chemoradiotherapy (CRT) fails to achieve local control for patients with esophageal squamous cell carcinoma (ESCC). However, salvage esophagectomy is a highly invasive procedure with various postoperative complications compared to planned esophagectomy after neoadjuvant chemoradiotherapy (CRT). We hypothesize that severe postoperative complications may affect not only surgical mortality but also tumor recurrence and long-term survival for patients with salvage esophagectomy after definitive CRT. Methods For the present study we reviewed the surgical procedures, postoperative complications, and the prognosis of 65 consecutive patients with thoracic ESCC who underwent the esophagectomy after neoadjuvant (neoadjuvant group: n  = 40) or definitive (salvage group: n  = 25) CRT. Results Most patients underwent right-transthoracic extended esophagectomy and reconstruction using gastric conduit by way of subcutaneous route with left cervical anastomosis. The incidence of postoperative pneumonia was found to be higher in the salvage group than in the neoadjuvant group. In both groups, the survival of patients with R0 resection was significantly better than those with R1/R2 resection. Moreover, in the salvage group, the postoperative survival rate of patients with pneumonia or bacteremia/sepsis was significantly lower than that for patients who did not suffer the same complications. In the neoadjuvant group, R0 resection was selected to be the only independent prognostic factor in univariate and multivariate analysis. In contrast, in the salvage group, R0 resection and bacteremia/sepsis remained significant and were independent of the other factors in multivariate analysis. Conclusions This study reveals that postoperative morbidity affects not only the perioperative mortality but also the long-term survival of patients with ESCC who undergo salvage esophagectomy after definitive CRT.