title: Salvage esophagectomy after failed definitive chemoradiation for esophageal adenocarcinoma.
abstract: BACKGROUND
  Outcomes of salvage esophagectomy after definitive chemoradiation (CRT) for squamous cell carcinoma are well defined. Previous reports of salvage esophagectomy in patients with recurrent adenocarcinoma after definitive CRT are limited by small numbers and high morbidity and mortality rates.
  
  
  METHODS
  We reviewed our experience of 65 patients with esophageal adenocarcinoma treated from 1997 to 2010 who underwent salvage esophagectomy after failed definitive CRT. We then compared this group to 65 matched patients of 521 total patients with esophageal adenocarcinoma who received preoperative CRT followed by planned esophagectomy. Propensity matching and multivariable analysis were performed.
  
  
  RESULTS
  Median time to surgery from completion of therapy for the salvage group was 216 days. Major postoperative events (major pulmonary event, conduit loss, leak, readmission to intensive care unit) occurred in 35% (23 of 65) of salvage patients and 31% (20 of 65) of the planned resection matched group. Anastomotic leak occurred in 18.5% (12 of 65) and 11.3 (59 of 521) of salvage and planned groups, respectively. Thirty-day mortality was 3.1% (2 of 65) after salvage resection and 4.6% (3 of 65) after planned resection. There was no difference in 3-year overall or median survival between the two groups of patients (32 months, 48% salvage, versus 40 months, 57% planned resection). Multivariable analysis did not identify salvage strategy or time from completion of therapy to resection as a predictor of major event or death.
  
  
  CONCLUSIONS
  Postoperative morbidity, mortality, and overall survival of patients after salvage esophagectomy are comparable to matched patients after planned resection. These results suggest that patients with esophageal adenocarcinoma who fail definitive CRT and recur locoregionally should be considered for salvage esophagectomy at experienced esophageal centers.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas 77030-4008, USA.
authors.forename: Jenifer L
authors.initials: JL
authors.lastname: Marks
authors.forename: Wayne
authors.initials: W
authors.lastname: Hofstetter
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Correa
authors.forename: Reza J
authors.initials: RJ
authors.lastname: Mehran
authors.forename: David
authors.initials: D
authors.lastname: Rice
authors.forename: Jack
authors.initials: J
authors.lastname: Roth
authors.forename: Garrett
authors.initials: G
authors.lastname: Walsh
authors.forename: Ara
authors.initials: A
authors.lastname: Vaporciyan
authors.forename: Jeremy
authors.initials: J
authors.lastname: Erasmus
authors.forename: Joe
authors.initials: J
authors.lastname: Chang
authors.forename: Dipen
authors.initials: D
authors.lastname: Maru
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Jared
authors.initials: J
authors.lastname: Lee
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Swisher
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome