title: Clinical significance of salvage esophagectomy for remnant or recurrent cancer following definitive chemoradiotherapy.
abstract: BACKGROUND
  The purpose of this study was to clarify the effect of preoperative chemoradiotherapy (CRT) for esophageal cancer on the postoperative course, and to determine the clinical significance of salvage esophagectomy after definitive CRT.
  
  
  METHODS
  Based on their preoperative treatment, 477 patients with esophageal cancer were classified into three groups: 253 patients who received surgery alone (Group I), 197 who received planned CRT (30-45 Gy, Group II), and 27 who received a salvage esophagectomy (radiation ≥60 Gy, Group III).
  
  
  RESULTS
  Postoperative complications developed in 25, 40, and 59% of the patients in Groups I, II, and III, respectively, with pulmonary complications developing in 10, 15, and 30%, and anastomotic leakage developing in 13, 23, and 37%, respectively. Mortality rates were 2.4, 2.0, and 7.4%, respectively. Multivariate analysis revealed preoperative therapy to be an independent factor associated with postoperative risks: the odds ratios (ORs) of Groups II and III compared to Group I were 1.8 and 4.0 for pulmonary complications, while they were 1.9 and 2.8, respectively, for anastomotic leakage. No critical complications developed in the 14 patients who received salvage surgery performed with strict surgical indications after 2005. The survival of Group III was not significantly different from that of Groups I and II. Most patients who received an R1/R2 resection after definitive CRT died within 2 years after salvage surgery.
  
  
  CONCLUSIONS
  Preoperative CRT is associated with postoperative complications especially in patients with R2 resection, while long-term survival can be achieved after R0 resections. Salvage surgery should be considered for carefully selected patients in whom R0 resection can be achieved.
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812- 8582, Japan. masarum@surg2.med.kyushu-u.ac.jp
authors.forename: Masaru
authors.initials: M
authors.lastname: Morita
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Kumashiro
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hisamatsu
authors.forename: Ryota
authors.initials: R
authors.lastname: Nakanishi
authors.forename: Akinori
authors.initials: A
authors.lastname: Egashira
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Saeki
authors.forename: Eiji
authors.initials: E
authors.lastname: Oki
authors.forename: Takefumi
authors.initials: T
authors.lastname: Ohga
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kakeji
authors.forename: Shunichi
authors.initials: S
authors.lastname: Tsujitani
authors.forename: Takeharu
authors.initials: T
authors.lastname: Yamanaka
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D011183:Postoperative Complications; D057234:Preoperative Period; D011379:Prognosis; D016879:Salvage Therapy; D016896:Treatment Outcome