title: Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy.
abstract: OBJECTIVE
  Some patients and oncologists choose to treat localized esophageal cancer with definitive chemotherapy and radiation therapy rather than surgery. A subset of these patients have local relapse without distant metastases and therefore have no other curative intent treatment option but salvage esophagectomy.
  
  
  METHODS
  We reviewed our experience with salvage esophagectomy from 1987 to 2000 at M.D. Anderson Cancer Center (n = 13, salvage after chemotherapy and radiotherapy group) and compared the data with those of patients receiving esophagectomy in a planned fashion 4 to 6 weeks after preoperative chemotherapy and radiation therapy (n = 99, preoperative chemotherapy and radiotherapy group).
  
  
  RESULTS
  Increases in morbidity were seen after resection in the salvage after chemotherapy and radiotherapy group relative to the preoperative chemotherapy and radiotherapy group: mechanical ventilation (9.0 days vs 3.3 days, P =.08), intensive care unit stay (11.2 days vs 5.1 days, P =.07), hospital stay (29.4 days vs 18.4 days, P =.03), and anastomotic leak rates (5/13 [39%] vs 7/99 [7%], P =.005). Operative mortality (within 30 days) also tended to be increased statistically nonsignificantly (2/13 [15%] vs 6/99 [6%], P =.2). Salvage esophagectomy resulted in long-term survival (25% 5-year survival) in a subset of patients. Improved survival after salvage esophagectomy was associated with early pathologic stage (T1 N0, T2 N0), prolonged time to relapse, and R0 surgical resection.
  
  
  CONCLUSIONS
  Patients who undergo salvage esophagectomy for relapse of tumor after definitive chemoradiation therapy have increased morbidity, mortality, and hospital use relative to patients undergoing planned esophagectomy after preoperative chemoradiation. Nevertheless, long-term survival can be achieved in this group, and such treatment should be considered for carefully selected patients at an experienced center.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. sswisher@mdanderson.org
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
authors.forename: Paula
authors.initials: P
authors.lastname: Wynn
authors.forename: Joe B
authors.initials: JB
authors.lastname: Putnam
authors.forename: Melinda B
authors.initials: MB
authors.lastname: Mosheim
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Ritsuko R
authors.initials: RR
authors.lastname: Komaki
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: W Roy
authors.initials: WR
authors.lastname: Smythe
authors.forename: Ara A
authors.initials: AA
authors.lastname: Vaporciyan
authors.forename: Jack A
authors.initials: JA
authors.lastname: Roth
authors.forename: Garrett L
authors.initials: GL
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D016879:Salvage Therapy; D015996:Survival Rate