PS02.140: OUTCOMES OF SALVAGE SURGERY IN PATIENTS WITH RECURRENT ESOPHAGEAL CANCER AFTER DEFINITIVE CHEMORADIOTHERAPY. (14th September 2018)

• Record Type: Journal Article
• Authors: Slaman, Annelijn; Eshuis, Wietse; Draaisma, Werner; Gisbertz, Suzanne; Bergman, Jacques; Van Laarhoven, Hanneke; Meijer, Sybren; Hulshof, Maarten; Van Berge Henegouwen, Mark I
• Is Part Of: Diseases of the esophagus. Volume 31(2018)Supplement 1
• Page Start: 160
• Page End: 160
• Publication Date: 2018-09-14
• Subjects: salvage surgery -- locoregional recurrence -- definitive chemoradiotherapy -- Esophageal cancer; Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doy089.PS02.140
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Background: Definitive chemoradiotherapy for esophageal cancer can be a treatment option in selected patients. In patients with locoregional recurrence after definitive chemoradiotherapy, additional curative esophagectomy may be possible, but evidence for this 'salvage' esophagectomy is limited. The aim of this study was to evaluate clinical outcomes of salvage esophagectomy after definitive chemoradiotherapy. Methods: A prospectively maintained database was used to select patients who underwent esophagectomy for locoregional recurrent cancer of the esophagus or gastroesophageal junction after dCRTx ('salvage esophagectomy') and patients who underwent curative esophagectomy following neoadjuvant chemoradiotherapy ('nCRTx esophagectomy') between January 2013 and January 2018. Patients underwent salvage resection without direct reconstruction (2-stage salvage procedure) or with a direct reconstruction. Perioperative outcomes of salvage esophagectomy were compared to nCRTX esophagectomy. Oncologic outcomes were evaluated using the Kaplan-Meier method. Results: A total of 16 patients underwent salvage esophagectomy and 330 patients underwent nCRTx esophagectomy during the study period. Direct reconstruction was performed in 3 patients (13.3%) of the salvage group versus 328 patients (99.1%) who underwent nCRTx esophagectomy ( P < 0.001). R0-resection rate was higher after esophagectomy following nCRTx than after salvage surgery (97.0% versus 68.8% respectively, P < 0.001). Difference in morbidity did not reach statistical significance (58.8% versus 81.3% respectively, P = 0.115). The combined (30-day and in-hospital) mortality and 90-day mortality were significantly higher after salvage esophagectomy (2.4% versus 31.1% and 4.7% versus 42.9%, both P < 0.001). Median follow-up of all surviving patients was 21.4 months (IQR, 10.0–36.2). The overall survival in the salvage group had a median of 4.3 months (95% CI, 0–10.0) versus a median of 43.7 months (95% CI, 33.9–53.5) in the nCRTx esophagectomy group. The cumulative 1-year and 3-year survival of the salvage group were 42.2% and 28.1%. Within 5 years after surgery all patients in the salvage esophagectomy group had died. Conclusion: Definitive chemoradiotherapy followed by esophagectomy for esophageal carcinomas is associated with a high proportion of R1 resections and high mortality rates. It is recommended to evaluate these results in larger patient cohorts. Salvage resections should only be performed in strongly selected patients. Disclosure: All authors have declared no conflicts of interest.