title: Prognostic analysis of salvage esophagectomy after definitive chemoradiotherapy for esophageal squamous cell carcinoma: the importance of lymphadenectomy.
abstract: OBJECTIVE
  The objective of this study was to review the prognostic factors for increased survival after salvage esophagectomy after definitive chemoradiotherapy for esophageal squamous carcinoma and determine the importance of lymphadenectomy from a prognostic view.
  
  
  METHODS
  Clinical data for all patients from January 1999 to December 2012 who underwent salvage esophagectomy for residual tumor or tumor recurrence after definitive chemoradiotherapy were retrospectively collected. Survival was determined and prognostic factors were analyzed with univariate and multivariate analyses.
  
  
  RESULTS
  Survival after 1, 3, and 5 years postoperatively was 74.4%, 39.8%, and 29.5%, respectively. The independent predictive factors for increased postoperative survival were tumor recurrence rather than residual tumor as the indication for salvage surgery (P < .001; odds ratio [OR], 0.292); complete tumor resection (P < .001; OR, 4.520); N category (P = .089; OR, 1.304); M category (P = .081; OR, 2.215), and total mediastinal dissection with 15 or more dissected mediastinal lymph nodes (P = .034; OR, 0.546).
  
  
  CONCLUSIONS
  Salvage indications of recurrence, earlier disease, and complete tumor resection are related to longer survival. The total area of mediastinal dissection with a sufficient number of dissected mediastinal lymph nodes improves survival. Additional neck dissection does not add benefit. The optimal procedure for lymph node dissection in salvage esophagectomy should be established in future studies.
authors: Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan; Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China.
authors: Shaohua
authors: S
authors: Wang
authors: Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan. Electronic address: ytachimo@ncc.go.jp.
authors: Yuji
authors: Y
authors: Tachimori
authors: Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors: Nobukazu
authors: N
authors: Hokamura
authors: Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors: Hiroyasu
authors: H
authors: Igaki
authors: Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors: Hidetsugu
authors: H
authors: Nakazato
authors: Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
authors: Takayoshi
authors: T
authors: Kishino
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000009:adverse effects / Q000401:mortality; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D018365:Neoplasm, Residual; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016879:Salvage Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D017211:Treatment Failure