Patient selection for salvage surgery after definitive chemoradiotherapy in esophageal squamous cell carcinoma
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ORIGINAL ARTICLE
Patient selection for salvage surgery after definitive chemoradiotherapy in esophageal squamous cell carcinoma Hiroki Harada 1 & Keishi Yamashita 1,2 & Chikatoshi Katada 3 & Hiromichi Ishiyama 4 & Takafumi Soeno 1 & Marie Washio 1 & Mikiko Sakuraya 1 & Hideki Ushiku 1 & Masahiro Niihara 1 & Kei Hosoda 1 & Naoki Hiki 1 Received: 12 March 2020 / Accepted: 10 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose With the widespread use of definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC), salvage surgery for recurrence/residual patients became prevalent. However, survival impact of salvage surgery remains obscure at present. Methods The updated clinical outcomes of salvage surgery were investigated to know its survival impact. Of the 155 ESCC patients who underwent dCRT between 2009 and 2016, we included 85 patients with recurrence or residual disease. The median follow-up was 65 months. Results Of the 85 patients with progression disease, there were 42 and 43 patients of recurrence and residual disease, respectively. Salvage surgery was performed in 27 patients after dCRT, including 15 patients who underwent salvage esophagectomy. The 5year overall survival (OS) of salvage surgery and otherwise patients was 66.1% and 14.5%, and the patients with salvage surgery had a significantly better prognosis (p < 0.0001). In the 15 patients who underwent salvage esophagectomy, residual disease, lymph node metastasis-positive (ycN+) after dCRT, and pathological lymph node metastasis-positive (ypN+) were significantly associated with poor prognosis (p = 0.0492, p = 0.0006, p = 0.0276), and the 5-year OS rates for the ycN/ypN combinations were 90%, 33.3%, and 0% in ycN−/ypN−, ycN+/ypN−, and ycN+/ypN+ patients, respectively (p = 0.0026). In a multivariate analysis, ycN+ was an independent poor prognostic factor (HR 13.6, 95% CI 1.65–286.8, p = 0.0154). Conclusions Survival impact of salvage surgery after dCRT is robust, and lymph node metastasis after dCRT may help determine the indication for salvage esophagectomy. Keywords Salvage surgery . Definitive chemoradiotherapy . Esophageal squamous cell carcinoma . Prognosis . Esophageal cancer
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01935-7) contains supplementary material, which is available to authorized users. * Naoki Hiki [email protected]
3
Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan
1
Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan
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Department of Radiology and Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0375, Japan
2
Division of Advanced Surgical Oncology, Department of Research and Development Center for New Medical Frontiers, Kitasato University School
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