Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology and Hepatology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Ophthalmology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
ASH 2024 Annual Meeting 2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Women’s Health Knowledge Hub Advances in Alzheimer’s

Navigating neuroimaging in Alzheimer disease care

PET imaging is playing an increasingly critical role in managing AD, but how can you effectively integrate it into clinical practice? Our expert-led program will empower you with practical strategies and real-world case studies.

This content is intended for healthcare professionals outside of the UK.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in:

17-06-2024 | Esophagus Resection | Dynamic Manuscript

Thoracoscopic salvage esophagectomy with prophylactic mediastinal lymph node dissection after definitive chemoradiotherapy for patients with esophageal cancer

Authors: Tetsuya Abe, Hironori Fujieda, Eiji Higaki, Koji Komori, Seiji Ito, Yasuhiro Shimizu

Published in: Surgical Endoscopy | Issue 8/2024

Login to get access

Abstract

Background

Salvage esophagectomy for residual tumor and localized relapses after definitive chemoradiotherapy (dCRT) for patients with esophageal cancer is associated with a high rate of postoperative complications and in-hospital mortality. In addition, there are many controversial issues associated with salvage esophagectomy, such as the acceptability of minimally invasive surgery and the need for prophylactic dissection of mediastinal lymph nodes. The aim of this study was to evaluate the safety and usefulness of thoracoscopic salvage esophagectomy with prophylactic mediastinal lymph node dissection.

Methods

The study included 31 patients who underwent thoracoscopic salvage esophagectomy with prophylactic mediastinal lymph node dissection after dCRT between 2013 and 2022 (salvage patients) and 610 nonsalvage patients who underwent conventional thoracoscopic esophagectomy during the same time period.

Results

Differences between the median ages and sexes of the 2 patient groups were not significant. The dominant location of tumors in the salvage patients was the upper thoracic esophagus. More salvage patients had clinical T4 disease. The salvage patients had a lower median number of retrieved mediastinal lymph nodes than the nonsalvage patients. The differences between the rates of R0, postoperative complications, and in-hospital deaths in the 2 patient groups were not significant. The 3-year overall survival (OS) rates for the salvage patients were 73%, with 3-year OS rates for R0 vs non-R0 of 81% vs 0%, p < 0.01 and pN0 vs pN1-3 of 89% vs 49%, p < 0.01.

Conclusion

Regarding short-term outcomes, prophylactic mediastinal lymph node dissection for patients undergoing thoracoscopic salvage esophagectomy was as safe as prophylactic dissection for patients undergoing conventional thoracoscopic esophagectomy. R0 surgery and pN0 are important factors for long-term survival in patients undergoing thoracoscopic salvage esophagectomy.
Appendix
Available only for authorised users
Literature
1.
Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA Jr, Al-Sarraf M, Byhardt R, Russell AH, Beitler JJ, Spencer S, Asbell SO, Graham MV, Leichman LL (1999) Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85–01). Radiation Therapy Oncology Group. JAMA 281:1623–1627CrossRefPubMed
2.
Minsky BD, Pajak TF, Ginsberg RJ, Pisansky TM, Martenson J, Komaki R, Okawara G, Rosenthal SA, Kelsen DP (2002) INT 0123 (Radiation Therapy Oncology Group 94–05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 20:1167–1174CrossRefPubMed
3.
Kato K, Muro K, Minashi K, Ohtsu A, Ishikura S, Boku N, Takiuchi H, Komatsu Y, Miyata Y, Fukuda H (2011) Phase II study of chemoradiotherapy with 5-fluorouracil and cisplatin for stage II-III esophageal squamous cell carcinoma: JCOG trial (JCOG 9906). Int J Radiat Oncol Biol Phys 81:684–690CrossRefPubMed
4.
Takeuchi H, Ito Y, Machida R, Kato K, Onozawa M, Minashi K, Yano T, Nakamura K, Tsushima T, Hara H, Okuno T, Hironaka S, Nozaki I, Ura T, Chin K, Kojima T, Seki S, Sakanaka K, Fukuda H, Kitagawa Y (2022) A single-arm confirmatory study of definitive chemoradiation therapy including salvage treatment for clinical stage II/III esophageal squamous cell carcinoma (JCOG0909 Study). Int J Radiat Oncol Biol Phys 114:454–462CrossRefPubMed
5.
Miyata H, Sugimura K, Kanemura T, Takeoka T, Sugase T, Tanaka K, Makino T, Yamashita K, Yamasaki M, Motoori M, Shiraishi O, Kimura Y, Yasuda T, Yano M, Doki Y (2022) Salvage surgery for recurrent disease after definitive chemoradiotherapy for esophageal squamous cell carcinoma. Ann Surg Oncol 29:5657–5665CrossRefPubMed
6.
Tachimori Y, Kanamori N, Uemura N, Hokamura N, Igaki H, Kato H (2009) Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg 137:49–54CrossRefPubMed
7.
Watanabe M, Mine S, Nishida K, Yamada K, Shigaki H, Matsumoto A, Sano T (2015) Salvage esophagectomy after definitive chemoradiotherapy for patients with esophageal squamous cell carcinoma: who really benefits from this high-risk surgery? Ann Surg Oncol 22:4438–4444CrossRefPubMed
8.
Markar S, Gronnier C, Duhamel A, Pasquer A, Théreaux J, du Rieu MC, Lefevre JH, Turner K, Luc G, Mariette C (2015) Salvage surgery after chemoradiotherapy in the management of esophageal cancer: is it a viable therapeutic option? J Clin Oncol 33:3866–3873CrossRefPubMed
9.
Mayanagi S, Haneda R, Inoue M, Ishii K, Tsubosa Y (2022) Selective lymphadenectomy for salvage esophagectomy in patients with esophageal squamous cell carcinoma. Ann Surg Oncol 29:4863–4870CrossRefPubMed
10.
Mitchell KG, Nelson DB, Corsini EM, Vaporciyan AA, Antonoff MB, Mehran RJ, Rice DC, Roth JA, Sepesi B, Walsh GL, Bhutani MS, Maru DM, Wu CC, Nguyen QN, Ajani JA, Swisher SG, Hofstetter WL (2020) Morbidity following salvage esophagectomy for squamous cell carcinoma: the MD Anderson experience. Dis Esophagus 33:067
11.
Hayami M, Watanabe M, Ishizuka N, Mine S, Imamura Y, Okamura A, Kurogochi T, Yamashita K (2018) Prognostic impact of postoperative pulmonary complications following salvage esophagectomy after definitive chemoradiotherapy. J Surg Oncol 117:1251–1259CrossRefPubMed
12.
Takeuchi M, Kawakubo H, Mayanagi S, Yoshida K, Fukuda K, Nakamura R, Suda K, Wada N, Takeuchi H, Kitagawa Y (2018) Postoperative pneumonia is associated with long-term oncologic outcomes of definitive chemoradiotherapy followed by salvage esophagectomy for esophageal cancer. J Gastrointest Surg 22:1881–1889CrossRefPubMed
13.
Sugimura K, Miyata H, Shinno N, Ushigome H, Asukai K, Hara H, Hasegawa S, Yamada D, Yamamoto K, Haraguchi N, Nishimura J, Motoori M, Wada H, Takahashi H, Yasui M, Omori T, Ohue M, Yano M (2020) Prognostic impact of postoperative complications following salvage esophagectomy for esophageal cancer after definitive chemoradiotherapy. Oncology 98:280–288CrossRefPubMed
14.
Takeuchi H, Saikawa Y, Oyama T, Ozawa S, Suda K, Wada N, Takahashi T, Nakamura R, Shigematsu N, Ando N, Kitajima M, Kitagawa Y (2010) Factors influencing the long-term survival in patients with esophageal cancer who underwent esophagectomy after chemoradiotherapy. World J Surg 34:2014CrossRef
15.
Watanabe M, Toh Y, Ishihara R, Kono K, Matsubara H, Miyazaki T, Morita M, Murakami K, Muro K, Numasaki H, Oyama T, Saeki H, Tanaka K, Tsushima T, Ueno M, Uno T, Yoshio T, Usune S, Takahashi A, Miyata H (2023) Comprehensive registry of esophageal cancer in Japan, 2015. Esophagus 20:1–28CrossRefPubMed
16.
Kataoka K, Takeuchi H, Mizusawa J, Ando M, Tsubosa Y, Koyanagi K, Daiko H, Matsuda S, Nakamura K, Kato K, Kitagawa Y (2016) A randomized Phase III trial of thoracoscopic versus open esophagectomy for thoracic esophageal cancer: Japan Clinical Oncology Group Study JCOG1409. Jpn J Clin Oncol 46:174–177CrossRefPubMed
17.
Abe T, Higaki E, Fujieda H, Saito H, Narita K, Komori K, Ito S, Shimizu Y (2023) Will robot-assisted minimally invasive esophagectomy improve patient outcomes compared to conventional minimally invasive esophagectomy? Mini-invasive Surgery 7:28
18.
Kawai R, Abe T, Uemura N, Fukaya M, Saito T, Komori K, Yokoyama Y, Nagino M, Shinoda M, Shimizu Y (2017) Feeding catheter gastrostomy with the round ligament of the liver prevents mechanical bowel obstruction after esophagectomy. Dis Esophagus 30:1–8CrossRefPubMed
19.
Rice TW, Ishwaran H, Hofstetter WL, Kelsen DP, Apperson-Hansen C, Blackstone EH (2016) Recommendations for pathologic staging (pTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals. Dis Esophagus 29:897–905CrossRefPubMed
20.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefPubMed
21.
Miyata H, Yamasaki M, Takiguchi S, Nakajima K, Fujiwara Y, Nishida T, Mori M, Doki Y (2009) Salvage esophagectomy after definitive chemoradiotherapy for thoracic esophageal cancer. J Surg Oncol 100:442–446CrossRefPubMed
22.
Gardner-Thorpe J, Hardwick RH, Dwerryhouse SJ (2007) Salvage oesophagectomy after local failure of definitive chemoradiotherapy. Br J Surg 94:1059–1066CrossRefPubMed
23.
Oki E, Morita M, Kakeji Y, Ikebe M, Sadanaga N, Egasira A, Nishida K, Koga T, Ohata M, Honboh T, Yamamoto M, Baba H, Maehara Y (2007) Salvage esophagectomy after definitive chemoradiotherapy for esophageal cancer. Dis Esophagus 20:301–304CrossRefPubMed
24.
Okamura A, Hayami M, Kozuki R, Takahashi K, Toihata T, Imamura Y, Mine S, Watanabe M (2020) Salvage esophagectomy for initially unresectable locally advanced T4 esophageal squamous cell carcinoma. Esophagus 17:59–66CrossRefPubMed
25.
Ishiyama K, Oguma J, Kubo K, Kanematsu K, Kurita D, Daiko H (2022) Salvage minimally invasive esophagectomy after definitive chemoradiotherapy for esophageal cancer can improve postoperative complications compared with salvage open esophagectomy. Surg Endosc 36:3504–3510CrossRefPubMed
26.
Taniyama Y, Sakurai T, Heishi T, Okamoto H, Sato C, Maruyama S, Onodera Y, Ishida H, Unno M, Kamei T (2018) Different strategy of salvage esophagectomy between residual and recurrent esophageal cancer after definitive chemoradiotherapy. J Thorac Dis 10:1554–1562CrossRefPubMedPubMedCentral
27.
Markar SR, Karthikesalingam A, Penna M, Low DE (2014) Assessment of short-term clinical outcomes following salvage esophagectomy for the treatment of esophageal malignancy: systematic review and pooled analysis. Ann Surg Oncol 21:922–931CrossRefPubMed
28.
Salassa JR, Pearson BW, Payne WS (1977) Gross and microscopical blood supply of the trachea. Ann Thorac Surg 24:100–107CrossRefPubMed
29.
Matsubara T, Ueda M, Nagao N, Takahashi T, Nakajima T, Nishi M (1998) Cervicothoracic approach for total mesoesophageal dissection in cancer of the thoracic esophagus. J Am Coll Surg 187:238–245CrossRefPubMed
30.
Udagawa H, Ueno M, Haruta S, Tanaka T, Mizuno A, Ohkura Y (2017) Re-evaluation of the role of thoracoscopic esophagectomy as a Japanese-style radical surgery. Esophagus 14:165–170CrossRefPubMedPubMedCentral
31.
Imai T, Abe T, Uemura N, Yoshida K, Shimizu Y (2018) Immediate extubation after esophagectomy with three-field lymphadenectomy enables early ambulation in patients with thoracic esophageal cancer. Esophagus 15:165–172CrossRefPubMed
32.
Wang S, Tachimori Y, Hokamura N, Igaki H, Nakazato H, Kishino T (2014) Prognostic analysis of salvage esophagectomy after definitive chemoradiotherapy for esophageal squamous cell carcinoma: the importance of lymphadenectomy. J Thorac Cardiovasc Surg 147:1805–1811CrossRefPubMed
Metadata
Title
Thoracoscopic salvage esophagectomy with prophylactic mediastinal lymph node dissection after definitive chemoradiotherapy for patients with esophageal cancer
Authors
Tetsuya Abe
Hironori Fujieda
Eiji Higaki
Koji Komori
Seiji Ito
Yasuhiro Shimizu
Publication date
17-06-2024
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 8/2024
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-024-10986-6

Other articles of this Issue 8/2024

Early gastric cancer of young patients treated by endoscopic submucosal dissection: focusing on the different characteristics and prognosis of elderly patients

Correction: A superior approach? The role of robotic sleeve gastrectomy in patients with super super obesity using the 2019–2022 MBSAQIP database

Task division by multiple console surgeons is beneficial for safe robotic pancreaticoduodenectomy implementation and education

Sustainability in surgical practice: a collaborative call toward environmental sustainability in operating rooms

External validation of the SHA2PE score and its comparison to the Oakland score for the prediction of safe discharge in patients with lower gastrointestinal bleeding

Comparison of totally robotic and totally laparoscopic gastrectomy for gastric cancer: a propensity score matching analysis

SPONSORED

Mastering chronic pancreatitis pain: A multidisciplinary approach and practical solutions

Severe pain is the most common symptom of chronic pancreatitis. In this webinar, experts share the latest insights in pain management for chronic pancreatitis patients. Experts from a range of disciplines discuss pertinent cases and provide practical suggestions for use within clinical practice.

Sponsored by:
  • Viatris
Developed by: Springer Healthcare
Watch now
Video
Image Credits