title: Salvage Surgery After Chemoradiotherapy in the Management of Esophageal Cancer: Is It a Viable Therapeutic Option?
abstract: OBJECTIVE
  The aim of this large multicenter study was to assess the impact of salvage esophagectomy after definitive chemoradiotherapy (SALV) on clinical outcome.
  
  
  METHODS
  Data from consecutive adult patients undergoing resection for esophageal cancer in 30 European centers from 2000 to 2010 were collected. First, groups undergoing SALV (n = 308) and neoadjuvant chemoradiotherapy followed by planned esophagectomy (NCRS; n = 540) were compared. Second, patients who benefited from SALV for persistent (n = 234) versus recurrent disease (n = 74) were compared. Propensity score matching and multivariable analyses were used to compensate for differences in some baseline characteristics.
  
  
  RESULTS
  SALV versus NCRS groups: In-hospital mortality was similar in both groups (8.4% v 9.3%). The only significant differences in complications were seen for anastomotic leak (17.2% v 10.7%; P = .007) and surgical site infection, which were both more frequent in the SALV group. At 3 years, groups had similar overall (43.3% v 40.1%; P = .542) and disease-free survival (39.2% v 32.8%; P = .232) after matching, along with a similar recurrence pattern. Persistent versus recurrent disease groups: There were no significant differences between groups in incidence of in-hospital mortality or major complications. At 3 years, overall (40.9% v 56.2%; P = .046) and disease-free survival (36.6% v 51.6%; P = .095) were lower in the persistent disease group.
  
  
  CONCLUSIONS
  The results of this large multicenter study from the modern era suggest that SALV can offer acceptable short- and long-term outcomes in selected patients at experienced centers. Persistent cancer after definitive chemoradiotherapy seems to be more biologically aggressive, with poorer survival compared with recurrent cancer.
authors.affiliation: Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Sheraz
authors.initials: S
authors.lastname: Markar
authors.affiliation: Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Gronnier
authors.affiliation: Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pasquer
authors.affiliation: Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Jérémie
authors.initials: J
authors.lastname: Théreaux
authors.affiliation: Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Mael Chalret
authors.initials: MC
authors.lastname: du Rieu
authors.affiliation: Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Jérémie H
authors.initials: JH
authors.lastname: Lefevre
authors.affiliation: Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Turner
authors.affiliation: Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Luc
authors.affiliation: Sheraz Markar, Imperial College, London, United Kingdom; Caroline Gronnier, Christophe Mariette, and Alain Duhamel, Site de Recherche Intégrée sur le Cancer OncoLille; North of France University; University Hospital of Lille; Caroline Gronnier and Christophe Mariette, INSERM UMR S-1172, Jean Pierre Aubert Research Center, Lille; Arnaud Pasquer and Christophe Mariette, Edouard Herriot University Hospital, Lyon; Jérémie Théreaux, Cavale Blanche University Hospital, Brest; Mael Chalret du Rieu, Purpan University Hospital, Toulouse; Jérémie H. Lefevre, Saint Antoine University Hospital, Paris; Kathleen Turner, Pontchaillou University Hospital, Rennes; and Guillaume Luc, Haut-Levêque University Hospital, Bordeaux, France. christophe.mariette@chru-lille.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D005060:Europe; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D057216:Propensity Score; D012189:Retrospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy / Q000379:methods* / Q000401:mortality; D016019:Survival Analysis