J.Jpn. Surg. Soc.. 109(1): 31-35, 2008

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Feature topic

SALVAGE SURGERY AFTER DEFINITIVE CHEMORADIATION FOR ESOPHAGEAL CARCINOMA

Definitive chemoradiation has become an effective modality for the treatment of advanced esophageal carcinoma, although local residual lesions or recurrence are detected in more than 50% of patients. For those patients, resection is the only salvage therapy. More than 40% of patients who undergo complete resection survive. After chemoradiation for esophageal carcinoma, severe adhesions may develop between the primary lesion and surrounding vital organs, leading to difficulty in R0 resection. Systemic function including the lungs, heart, and bone marrow could be also severely impaired. This may result in many severe complications after salvage surgery, such as airway necrosis or mediastinitis. To reduce complications, we restrict lymph node dissection, conserve the right bronchial artery, and reconstruct with a gastric tube through the poststernal course. It is also important to modify the method in each case.
The more patients select chemoradiation for curative therapy of esophageal carcinoma, the more salvage surgery is needed. Surgeons should consider the indications and techniques for esophageal surgery to increase cure rates and decrease morbidity.

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