title: Complications of the rescue esophagectomy in advanced esophageal cancer.
abstract: BACKGROUND
  Even though the esophageal cancer has innumerous treatment options its prognosis is still unsettled. Because esophagectomy is rarely curative, new and emerging therapies come to light such as isolated chemotherapy and radiotherapy or combined chemoradiation, followed or not by surgery. The rescue esophagectomy is an alternative for those patients with recurrent or advanced disease.
  
  
  OBJECTIVE
  To evaluate the results of the rescue esophagectomy in patients with esophageal cancer who had previously undergone chemoradiation and describe local and systemic complications of the procedure.
  
  
  METHODS
  Eighteen patients with unresectable esophageal squamous cell carcinoma were treated with chemoradiation followed by rescue esophagectomy. All of them presented the preoperative clinical conditions required to indicate the surgical procedure. Transthoracic esophagectomy with right side thoracotomy plus midline laparotomy was performed. Patients were evaluated with regard to any postoperative complications.
  
  
  RESULTS
  There were five patients with evidence of fistula at the level of the anastomosis, and four of them progressed satisfactorily. Postoperative dilation was needed in five out of eighteen patients due to stenosis of the esophagogastric suture line. Seven patients did develop pulmonary infection with a fatal outcome for two of them. Among the patients who were available for a five-year follow-up, there was a rate of 53.8% of disease-free survival.
  
  
  CONCLUSIONS
  These patients presented an elevated morbidity of the procedure related to many factors such as the long period between chemoradiation and surgery, which leads to tissue injury resulting in anastomotic fistulas. Nevertheless, esophagectomy seems to be valuable in cases without any other therapeutic option.
authors.forename: José Luis Braga de
authors.initials: JL
authors.lastname: Aquino
authors.forename: Marcelo Manzano
authors.initials: MM
authors.lastname: Said
authors.forename: Douglas Alexandre Rizzanti
authors.initials: DA
authors.lastname: Pereira
authors.forename: Gustavo Nardini
authors.initials: GN
authors.lastname: Cecchino
authors.forename: Vânia Aparecida
authors.initials: VA
authors.lastname: Leandro-Merhi
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies