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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 5/2018

01-05-2018 | Thoracic Oncology

Salvage Surgery for Esophageal Cancer: How to Improve Outcomes?

Authors: Charlotte Cohen, MD, Williams Tessier, MD, Caroline Gronnier, MD, PhD, Florence Renaud, MD, Arnaud Pasquer, MD, Jérémie Théreaux, MD, Johan Gagnière, MD, Bernard Meunier, MD, Denis Collet, MD, PhD, Guillaume Piessen, MD, PhD, Christophe Mariette, MD, PhD, FREGAT (French Eso-Gastric Tumors working group) – FRENCH (Fédération de Recherche en Chirurgie) – AFC (Association Française de Chirurgie)

Published in: Annals of Surgical Oncology | Issue 5/2018

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Abstract

Background

Locoregional recurrence rates after definitive chemoradiotherapy (dCRT) for locally advanced esophageal cancer (EC) are high. Salvage surgery (SALV) is considered the best treatment option in case of persistent or recurrent disease for operable patients, but SALV has been associated with increased morbidity and mortality. The aim of this study is to identify factors linked to outcomes after SALV to better select candidates and to optimize perioperative care.

Study Design

We retrospectively analyzed data from 308 consecutive SALV patients from a large multicenter European cohort. Univariate and multivariate analyses were performed to identify factors associated with in-hospital postoperative morbidity, anastomotic leakage (AL), and overall survival (OS).

Results

The in-hospital postoperative mortality and morbidity rates were 8.4 and 34.7%, respectively. Squamous cell histology (p = 0.040) and radiation dose ≥ 55 Gy (p = 0.047) were independently associated with major morbidity. The AL rate was 12.7%, and cervical anastomosis was independently associated with AL (p = 0.002). OS at 5 years was 34.0%. Radiation dose ≥ 55 Gy (p = 0.003), occurrence of postoperative complications (p = 0.006), ypTNM stage 3 (p = 0.019), and positive surgical margins (p < 0.001) were linked to poor prognosis.

Conclusions

SALV is a valuable option for patients with persistent or recurrent disease after dCRT and offers long-term survival. Factors such as radiation dose and anastomosis location identified here will help to optimize outcomes after SALV, which may be considered a standard treatment in the EC therapeutic armamentarium.
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Metadata
Title
Salvage Surgery for Esophageal Cancer: How to Improve Outcomes?
Authors
Charlotte Cohen, MD
Williams Tessier, MD
Caroline Gronnier, MD, PhD
Florence Renaud, MD
Arnaud Pasquer, MD
Jérémie Théreaux, MD
Johan Gagnière, MD
Bernard Meunier, MD
Denis Collet, MD, PhD
Guillaume Piessen, MD, PhD
Christophe Mariette, MD, PhD
FREGAT (French Eso-Gastric Tumors working group) – FRENCH (Fédération de Recherche en Chirurgie) – AFC (Association Française de Chirurgie)
Publication date
01-05-2018
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 5/2018
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6365-1

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