Factors influencing the long-term survival in patients with esophageal cancer who underwent esophagectomy after chemoradiotherapy

Hiroya Takeuchi, Yoshiro Saikawa, Takashi Oyama, Soji Ozawa, Koichi Suda, Norihito Wada, Tsunehiro Takahashi, Rieko Nakamura, Naoyuki Shigematsu, Nobutoshi Ando, Masaki Kitajima, Yuukou Kitagawa

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background: Salvage esophagectomy is potentially the only treatment available that can offer a chance of long-term survival when definitive chemoradiotherapy (CRT) fails to achieve local control for patients with esophageal squamous cell carcinoma (ESCC). However, salvage esophagectomy is a highly invasive procedure with various postoperative complications compared to planned esophagectomy after neoadjuvant chemoradiotherapy (CRT). We hypothesize that severe postoperative complications may affect not only surgical mortality but also tumor recurrence and long-term survival for patients with salvage esophagectomy after definitive CRT. Methods: For the present study we reviewed the surgical procedures, postoperative complications, and the prognosis of 65 consecutive patients with thoracic ESCC who underwent the esophagectomy after neoadjuvant (neoadjuvant group: n = 40) or definitive (salvage group: n = 25) CRT. Results: Most patients underwent right-transthoracic extended esophagectomy and reconstruction using gastric conduit by way of subcutaneous route with left cervical anastomosis. The incidence of postoperative pneumonia was found to be higher in the salvage group than in the neoadjuvant group. In both groups, the survival of patients with R0 resection was significantly better than those with R1/R2 resection. Moreover, in the salvage group, the postoperative survival rate of patients with pneumonia or bacteremia/sepsis was significantly lower than that for patients who did not suffer the same complications. In the neoadjuvant group, R0 resection was selected to be the only independent prognostic factor in univariate and multivariate analysis. In contrast, in the salvage group, R0 resection and bacteremia/sepsis remained significant and were independent of the other factors in multivariate analysis. Conclusions: This study reveals that postoperative morbidity affects not only the perioperative mortality but also the long-term survival of patients with ESCC who undergo salvage esophagectomy after definitive CRT.

Original languageEnglish
Pages (from-to)277-284
Number of pages8
JournalWorld Journal of Surgery
Volume34
Issue number2
DOIs
Publication statusPublished - 2010 Feb

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Esophagectomy
Chemoradiotherapy
Esophageal Neoplasms
Survival
Bacteremia
Sepsis
Pneumonia
Multivariate Analysis
Mortality
Patient Rights
Stomach
Thorax
Survival Rate
Morbidity
Recurrence
Incidence
Esophageal Squamous Cell Carcinoma
Neoplasms

ASJC Scopus subject areas

  • Surgery

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Factors influencing the long-term survival in patients with esophageal cancer who underwent esophagectomy after chemoradiotherapy. / Takeuchi, Hiroya; Saikawa, Yoshiro; Oyama, Takashi; Ozawa, Soji; Suda, Koichi; Wada, Norihito; Takahashi, Tsunehiro; Nakamura, Rieko; Shigematsu, Naoyuki; Ando, Nobutoshi; Kitajima, Masaki; Kitagawa, Yuukou.

In: World Journal of Surgery, Vol. 34, No. 2, 02.2010, p. 277-284.

Research output: Contribution to journalArticle

Takeuchi, Hiroya ; Saikawa, Yoshiro ; Oyama, Takashi ; Ozawa, Soji ; Suda, Koichi ; Wada, Norihito ; Takahashi, Tsunehiro ; Nakamura, Rieko ; Shigematsu, Naoyuki ; Ando, Nobutoshi ; Kitajima, Masaki ; Kitagawa, Yuukou. / Factors influencing the long-term survival in patients with esophageal cancer who underwent esophagectomy after chemoradiotherapy. In: World Journal of Surgery. 2010 ; Vol. 34, No. 2. pp. 277-284.
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AU - Takeuchi, Hiroya

AU - Saikawa, Yoshiro

AU - Oyama, Takashi

AU - Ozawa, Soji

AU - Suda, Koichi

AU - Wada, Norihito

AU - Takahashi, Tsunehiro

AU - Nakamura, Rieko

AU - Shigematsu, Naoyuki

AU - Ando, Nobutoshi

AU - Kitajima, Masaki

AU - Kitagawa, Yuukou

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N2 - Background: Salvage esophagectomy is potentially the only treatment available that can offer a chance of long-term survival when definitive chemoradiotherapy (CRT) fails to achieve local control for patients with esophageal squamous cell carcinoma (ESCC). However, salvage esophagectomy is a highly invasive procedure with various postoperative complications compared to planned esophagectomy after neoadjuvant chemoradiotherapy (CRT). We hypothesize that severe postoperative complications may affect not only surgical mortality but also tumor recurrence and long-term survival for patients with salvage esophagectomy after definitive CRT. Methods: For the present study we reviewed the surgical procedures, postoperative complications, and the prognosis of 65 consecutive patients with thoracic ESCC who underwent the esophagectomy after neoadjuvant (neoadjuvant group: n = 40) or definitive (salvage group: n = 25) CRT. Results: Most patients underwent right-transthoracic extended esophagectomy and reconstruction using gastric conduit by way of subcutaneous route with left cervical anastomosis. The incidence of postoperative pneumonia was found to be higher in the salvage group than in the neoadjuvant group. In both groups, the survival of patients with R0 resection was significantly better than those with R1/R2 resection. Moreover, in the salvage group, the postoperative survival rate of patients with pneumonia or bacteremia/sepsis was significantly lower than that for patients who did not suffer the same complications. In the neoadjuvant group, R0 resection was selected to be the only independent prognostic factor in univariate and multivariate analysis. In contrast, in the salvage group, R0 resection and bacteremia/sepsis remained significant and were independent of the other factors in multivariate analysis. Conclusions: This study reveals that postoperative morbidity affects not only the perioperative mortality but also the long-term survival of patients with ESCC who undergo salvage esophagectomy after definitive CRT.

AB - Background: Salvage esophagectomy is potentially the only treatment available that can offer a chance of long-term survival when definitive chemoradiotherapy (CRT) fails to achieve local control for patients with esophageal squamous cell carcinoma (ESCC). However, salvage esophagectomy is a highly invasive procedure with various postoperative complications compared to planned esophagectomy after neoadjuvant chemoradiotherapy (CRT). We hypothesize that severe postoperative complications may affect not only surgical mortality but also tumor recurrence and long-term survival for patients with salvage esophagectomy after definitive CRT. Methods: For the present study we reviewed the surgical procedures, postoperative complications, and the prognosis of 65 consecutive patients with thoracic ESCC who underwent the esophagectomy after neoadjuvant (neoadjuvant group: n = 40) or definitive (salvage group: n = 25) CRT. Results: Most patients underwent right-transthoracic extended esophagectomy and reconstruction using gastric conduit by way of subcutaneous route with left cervical anastomosis. The incidence of postoperative pneumonia was found to be higher in the salvage group than in the neoadjuvant group. In both groups, the survival of patients with R0 resection was significantly better than those with R1/R2 resection. Moreover, in the salvage group, the postoperative survival rate of patients with pneumonia or bacteremia/sepsis was significantly lower than that for patients who did not suffer the same complications. In the neoadjuvant group, R0 resection was selected to be the only independent prognostic factor in univariate and multivariate analysis. In contrast, in the salvage group, R0 resection and bacteremia/sepsis remained significant and were independent of the other factors in multivariate analysis. Conclusions: This study reveals that postoperative morbidity affects not only the perioperative mortality but also the long-term survival of patients with ESCC who undergo salvage esophagectomy after definitive CRT.

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