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World Journal of Surgery
Published in: World Journal of Surgery 9/2018

01-09-2018 | Original Scientific Report

Prognostic Factors of Salvage Esophagectomy for Residual or Recurrent Esophageal Squamous Cell Carcinoma After Definitive Chemoradiotherapy

Authors: Yuki Kiyozumi, Naoya Yoshida, Takatsugu Ishimoto, Taisuke Yagi, Yuki Koga, Tomoyuki Uchihara, Hiroshi Sawayama, Yukiharu Hiyoshi, Masaaki Iwatsuki, Yoshifumi Baba, Yuji Miyamoto, Masayuki Watanabe, Tomohiko Matsuyama, Natsuo Oya, Hideo Baba

Published in: World Journal of Surgery | Issue 9/2018

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Abstract

Background

The aim of this study was to confirm prognostic factors for salvage esophagectomy for remnant or recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy.

Study design

We retrospectively analyzed clinicopathological backgrounds of 50 patients who underwent salvage esophagectomy between April 2005 and January 2016. Salvage esophagectomy comprised 40 three-incision esophagectomies, two transhiatal esophagectomies and eight pharyngolaryngoesophagectomies. Independent prognostic factors for overall survival were assessed using Cox regression analysis of the factors.

Results

Salvage esophagectomy remains a highly invasive surgery and correlated with a higher incidence of all morbidities of Clavien–Dindo classification (CDc) ≥II, severe morbidities of CDc ≥ IIIb, any pulmonary morbidities and chylorrhea, compared with those in patients without preoperative definitive chemoradiotherapy. Cox regression analysis suggested that R0 resection (hazard ratio [HR] 6.39; 95% confidence interval [CI] 2.03–9.68, P = 0.002), absence of severe complications (HR 4.97; 95% CI 1.70–14.81, P = 0.004) and early pStage (0–II) (HR 3.42; 95% CI 1.24–10.12, P = 0.018) were independent prognostic factors for salvage esophagectomy.

Conclusions

Salvage esophagectomy remains correlated with a high incidence of postoperative complications. Avoiding non-curative surgery and reducing the incidence of severe postoperative complications are important if patients are to receive prognostic benefit of this highly invasive surgery.
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Metadata
Title
Prognostic Factors of Salvage Esophagectomy for Residual or Recurrent Esophageal Squamous Cell Carcinoma After Definitive Chemoradiotherapy
Authors
Yuki Kiyozumi
Naoya Yoshida
Takatsugu Ishimoto
Taisuke Yagi
Yuki Koga
Tomoyuki Uchihara
Hiroshi Sawayama
Yukiharu Hiyoshi
Masaaki Iwatsuki
Yoshifumi Baba
Yuji Miyamoto
Masayuki Watanabe
Tomohiko Matsuyama
Natsuo Oya
Hideo Baba
Publication date
01-09-2018
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 9/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-018-4536-7

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