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Salvage esophagectomy after failure of definitive radiochemotherapy for esophageal cancer

par Farinella, Eleonora;Safar, Adonis;Nasser, Haydar ;Bouazza, F.;Liberale, Gabriel ;Paesmans, Marianne ;Marechal, Raphaël ;Van Laethem, Jean-Luc ;Hendlisz, Alain ;Van Houtte, Paul ;El Nakadi, Issam
Référence Journal of surgical oncology, 114, 7, page (833-837)
Publication Publié, 2016-12

Article révisé par les pairs

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Résumé :

Background: Definitive radiochemotherapy (dRCT) in locally advanced esophageal cancer is associated with a high rate of loco-regional recurrence. In this condition, salvage esophagectomy may be considered as a therapeutic option. The aim of this analysis is to evaluate the feasibility and the morbi-mortality of this strategy. Methods: Between January 2006 and April 2014, 208 patients underwent esophagectomy for esophageal cancer at ULB-Erasme-Bordet. Thirty-two patients received a preoperative radiochemotherapy (pRCT) followed by planned esophagectomy (Group 1) for locally advanced disease. Sixteen patients underwent salvage esophagectomy for recurrence or failure after dRCT (Group 2). Data on post-operative morbidity and mortality and survival were collected and analyzed. Results: An increase of overall morbidity was detected in Group 2 as compared to Group 1 (43% vs. 37.5%), mainly related to respiratory complications (35.5% vs. 28%) and anastomotic leak (25% vs. 3%). No 90-days mortality was observed in the two surgical groups. The 1, 2, and 3-year survival rates after surgery were respectively 89%, 80%, and 71% for Group1 and 84%, 73%, and 63% for Group 2. Conclusions: In our experience, both salvage esophagectomy and esophagectomy after pRCT showed good survival results with low postoperative morbidity and mortality. Salvage surgery remains a therapeutic indication in selected patients. J. Surg. Oncol. 2016;114:833–837. © 2016 2016 Wiley Periodicals, Inc.