J.Jpn. Surg. Soc.. 121(4): 448-452, 2020

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Feature topic

CURRENT STATUS AND FUTURE DIRECTION OF DEFINITIVE CHEMORADIOTHERAPY AND SALVAGE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Definitive chemoradiotherapy (dCRT) is a curative-intent treatment choice for patients with esophageal squamous cell carcinoma. Patients in almost all disease stages are candidates for dCRT, except for those with superficial lesions that can be cured with endoscopic resection and those with distant metastasis. For patients with clinical stage I disease, dCRT showed equivalent long-term survival as esophagectomy. Although neoadjuvant chemotherapy followed by esophagectomy is the standard of care for patients with clinical stage II/III disease, dCRT is an alternative. For patients with locally advanced unresectable tumors, dCRT is a standard treatment modality that may provide cure. For patients who failed dCRT, salvage esophagectomy may offer a chance of long-term survival. However, salvage esophagectomy is associated with a high incidence of morbidity and mortality. Therefore, the surgical indications for such cases should be determined based on the risk–benefit balance in clinical practice. From the results of previous studies, appropriate patient selection and R0 resection might provide long-term survival. Postoperative complications after salvage esophagectomy are known to impair the long-term outcomes, and the efficacy of a multidisciplinary perioperative team is receiving increased attention.

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