Journal
JOURNAL OF SURGICAL ONCOLOGY
Volume 93, Issue 5, Pages 422-428Publisher
WILEY
DOI: 10.1002/jso.20475
Keywords
esophageal cancer; salvage surgery; operative indication; prognosis
Ask authors/readers for more resources
Background and Objectives: Although salvage Surgery after definitive chemoradiotherapy (CRT) is common, the safety and indication has not yet been established. Methods: We retrospectively compared the mortality and morbidity of 24 patients who underwent salvage surgery with those of historical controls treated with neoadjuvant CRT followed by planned esophagectomy during the same period, and analyzed the prognostic factor of salvage surgery. Results: Preoperative serum albumin (3.7 vs. 4.1 g/dl, P = 0.0157) and lymphocyte count (763 vs. 964/mm(3), P=0.0111) in the salvage group were significantly lower. A significant difference was also observed * than those in the neoadjuvant group in operation time (567 vs. 474 min, P=0.0381), C-reactive protein (CRP) on postoperative day 1 (11.2 vs. 8.7 mo/dl, P=0.0021), and postoperative systemic inflammatory response syndrome (SIRS) duration (3.5 vs. 2.9 days, P = 0.0486). There were three hospital deaths in the salvage group, whereas no patient died in the neoadjuvant group. Multivariate analysis showed curability (R0 vs. R1+R2) to be the strongest procynostic factor of salvage surgery (P = 0.0064). R1+R2 operation was more frequently performed in the salvage group (33% vs. 13%), and the reason for all cases was unresectable T4, which had been underestimated preoperatively. Conclusions: Salvage surgery is a highly invasive and morbid operation, which is performed on immunocompromized hosts. The indication must be carefully considered, with care taken to avoid non-curative surgery.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available