J.Jpn. Surg. Soc.. 112(2): 117-121, 2011

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Feature topic

SALVAGE ESOPHAGECTOMY AFTER DEFINITIVE CHEMORADIOTHERAPY

Salvage surgery is the sole curative-intent treatment option for patients with esophageal cancer after definitive chemoradiotherapy. The most significant factor associated with long-term survival appears to be R0 resection. Patients who undergo salvage esophagectomy have high morbidity and mortality rates. Extended three-field lymphadenectomy should be limited in salvage surgery. Ischemic tracheobronchial lesions are serious complications of salvage esophagectomy. The right posterior bronchial artery should be preserved, and neck dissection should be avoided to preserve the blood supply from the inferior thyroidal artery to the trachea. The anastomotic leak rate is also significantly increased after salvage esophagectomy. Irradiation of the esophagus and stomach may affect the blood supply, which may then contribute to leakage. Gastric conduit necrosis in the posterior mediastinum can cause mortal mediastinitis, necessitating surgical modifications to reduce the impact of leaks into the thoracic cavity. The reconstruction route was changed to the anterior mediastinum with cervical anastomosis. Long-term or late cardiopulmonary toxicity cannot be ignored in patients who undergo salvage esophagectomy. A high morbidity rate is acceptable in view of the potential for long-term survival after salvage esophagectomy. Patients should be carefully selected for salvage esophagectomy after high-dose chemoradiotherapy at referral centers that specialize in esophageal cancer treatment.

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