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Ebert MP, Fischbach W, Hollerbach S, Höppner J, Lorenz D, Stahl M, Stuschke M, Pech O, Vanhoefer U, Porschen R. S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:535-642. [PMID: 38599580 DOI: 10.1055/a-2239-9802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Affiliation(s)
- Matthias P Ebert
- II. Medizinische Klinik, Medizinische Fakultät Mannheim, Universitätsmedizin, Universität Heidelberg, Mannheim
- DKFZ-Hector Krebsinstitut an der Universitätsmedizin Mannheim, Mannheim
- Molecular Medicine Partnership Unit, EMBL, Heidelberg
| | - Wolfgang Fischbach
- Deutsche Gesellschaft zur Bekämpfung der Krankheiten von Magen, Darm und Leber sowie von Störungen des Stoffwechsels und der Ernährung (Gastro-Liga) e. V., Giessen
| | | | - Jens Höppner
- Klinik für Allgemeine Chirurgie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck
| | - Dietmar Lorenz
- Chirurgische Klinik I, Allgemein-, Viszeral- und Thoraxchirurgie, Klinikum Darmstadt, Darmstadt
| | - Michael Stahl
- Klinik für Internistische Onkologie und onkologische Palliativmedizin, Evang. Huyssensstiftung, Evang. Kliniken Essen-Mitte, Essen
| | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Oliver Pech
- Klinik für Gastroenterologie und Interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Udo Vanhoefer
- Klinik für Hämatologie und Onkologie, Katholisches Marienkrankenhaus, Hamburg
| | - Rainer Porschen
- Gastroenterologische Praxis am Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck
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Pai CP, Chien LI, Huang CS, Hsu HS, Hsu PK. Treatment Outcomes and Risk Factors for Incomplete Treatment after Definitive Chemoradiotherapy for Non-Resectable or Metastatic Esophageal Cancer. Cancers (Basel) 2023; 15:5421. [PMID: 38001681 PMCID: PMC10670551 DOI: 10.3390/cancers15225421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/03/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Among patients with unresectable or metastatic esophageal cancer who receive definitive chemotherapy or chemoradiotherapy, the rates of treatment-related adverse events and incomplete treatment remain high. We conducted this study to investigate survival after definitive treatments and identify predicting factors for incomplete treatment. The data of patients who received definitive chemotherapy or chemoradiotherapy for esophageal cancer were retrospectively examined. The patients were assigned to Group 1: incomplete definitive treatment; Group 2: complete definitive treatment; or Group 3: complete definitive treatment with additional salvage surgery. The data of 273 patients (90, 166, and 17 in Groups 1, 2, and 3, respectively) were analyzed. In the survival analysis, the median overall survival of Groups 1, 2, and 3 were 2.6, 10.3, and 29.5 months, respectively. A significant difference in 3-year overall survival was observed among the groups (2.2%, 12.4%, and 48.5%, p < 0.001). In multivariable analysis, the independent risk factors for incomplete definitive treatment included poor performance score (hazard ratio (HR): 5.23, p = 0.001), bone metastasis (HR: 2.18, p = 0.024), airway invasion (HR: 2.90, p = 0.001), and liver cirrhosis (HR: 3.20, p = 0.026). Incomplete definitive treatment is associated with a far worse prognosis. Poor performance, bone metastasis, airway invasion, and liver cirrhosis are risk factors for incomplete treatment.
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Affiliation(s)
- Chu-Pin Pai
- Division of Thoracic Surgery, Department of Surgery, Lotung Poh-Ai Hospital, Ilan 26546, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan; (C.-S.H.); (H.-S.H.)
| | - Ling-I Chien
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Chien-Sheng Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan; (C.-S.H.); (H.-S.H.)
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Han-Shui Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan; (C.-S.H.); (H.-S.H.)
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - Po-Kuei Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 30010, Taiwan; (C.-S.H.); (H.-S.H.)
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112201, Taiwan
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S3-Leitlinie Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:e209-e307. [PMID: 37285869 DOI: 10.1055/a-1771-6953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Sakai M, Saeki H, Sohda M, Korematsu M, Miyata H, Murakami D, Baba Y, Ishii R, Okamoto H, Shibata T, Shirabe K, Toh Y, Shiotani A. Primary tracheobronchial necrosis after esophagectomy: A nationwide multicenter retrospective study in Japan. Ann Gastroenterol Surg 2023; 7:236-246. [DOI: doi.org/10.1002/ags3.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/14/2022] [Indexed: 09/03/2023] Open
Abstract
AbstractBackgroundThe clinical features of postoperative primary tracheobronchial necrosis (P‐TBN; the necrosis without anastomotic leakage or other cervical and mediastinal abscess) remains unclear. This nationwide multicenter retrospective study first investigated the clinical features of P‐TBN after esophagectomy for upper aerodigestive tract cancer with a large cohort.MethodsAs a study of the Japan Broncho‐Esophagological Society, a nationwide questionnaire survey was conducted in 67 institutions. The clinical data of 6370 patients who underwent esophagectomy for laryngeal, pharyngeal, and esophageal cancer between 2010 and 2019 were collected. Grades of P‐TBN were defined as follows: Grade 1, mucosal necrosis; Grade 2, transmural bronchial wall necrosis without fistula or perforation; Grade 3, transmural bronchial wall necrosis with fistula or perforation.ResultsP‐TBN was observed in 48 (0.75%) of 6370 patients. The incidences of P‐TBN for pharyngo‐laryngo‐cervical esophagectomy (PLCE; n = 1650), total pharyngo‐laryngo‐esophagectomy (TPLE; n = 205), and subtotal esophagectomy (SE; n = 4515) were 2.0%, 5.4%, and 0.1%, respectively. The upper mediastinal LN dissection (P = 0.016) and the higher level of the tracheal resection (P = 0.039) were significantly associated with a higher grade of necrosis in PLCE and TPLE. Overall survival rates were significantly lower in patients with Grade 2 (P = 0.009) and Grade 3 (P = 0.004) than in those with Grade 1.ConclusionThe incidence of TBN restricted to P‐TBN was lower than previously reported. Maintaining the tracheal blood flow is essential to prevent worsening P‐TBN, especially in PLCE and TPLE. Our new P‐TBN severity grade may predict the outcome of patients with P‐TBN.
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Affiliation(s)
- Makoto Sakai
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine Gunma University Maebashi Japan
| | - Hiroshi Saeki
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine Gunma University Maebashi Japan
| | - Makoto Sohda
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of Medicine Gunma University Maebashi Japan
| | - Mizuki Korematsu
- Department of Head and Neck Surgery Osaka International Cancer Institute Osaka Japan
| | - Hiroshi Miyata
- Department of Digestive Surgery Osaka International Cancer Institute Osaka Japan
| | - Daizo Murakami
- Department of Otolaryngology‐Head and Neck Surgery, Graduate School of Medicine Kumamoto University Kumamoto Japan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science Kumamoto University Kumamoto Japan
| | - Ryo Ishii
- Department of Otolaryngology‐Head and Neck Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Hiroshi Okamoto
- Department of Gastroenterological Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Tomotaka Shibata
- Advanced Trauma, Emergency and Critical Care Center/Gastroenterological and Pediatric Surgery Oita University Hospital Yufu Japan
| | - Ken Shirabe
- Department of General Surgical Science Gunma University Graduate School of Medicine Maebashi Japan
| | - Yasushi Toh
- National Hospital Organization Kyushu Cancer Center Fukuoka Japan
| | - Akihiro Shiotani
- Department of Otolaryngology‐ Head and Neck Surgery National Defense Medical College Saitama Japan
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Sakai M, Saeki H, Sohda M, Korematsu M, Miyata H, Murakami D, Baba Y, Ishii R, Okamoto H, Shibata T, Shirabe K, Toh Y, Shiotani A. Primary tracheobronchial necrosis after esophagectomy: A nationwide multicenter retrospective study in Japan. Ann Gastroenterol Surg 2022; 7:236-246. [PMID: 36998306 PMCID: PMC10043765 DOI: 10.1002/ags3.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/14/2022] [Indexed: 04/01/2023] Open
Abstract
Background The clinical features of postoperative primary tracheobronchial necrosis (P-TBN; the necrosis without anastomotic leakage or other cervical and mediastinal abscess) remains unclear. This nationwide multicenter retrospective study first investigated the clinical features of P-TBN after esophagectomy for upper aerodigestive tract cancer with a large cohort. Methods As a study of the Japan Broncho-Esophagological Society, a nationwide questionnaire survey was conducted in 67 institutions. The clinical data of 6370 patients who underwent esophagectomy for laryngeal, pharyngeal, and esophageal cancer between 2010 and 2019 were collected. Grades of P-TBN were defined as follows: Grade 1, mucosal necrosis; Grade 2, transmural bronchial wall necrosis without fistula or perforation; Grade 3, transmural bronchial wall necrosis with fistula or perforation. Results P-TBN was observed in 48 (0.75%) of 6370 patients. The incidences of P-TBN for pharyngo-laryngo-cervical esophagectomy (PLCE; n = 1650), total pharyngo-laryngo-esophagectomy (TPLE; n = 205), and subtotal esophagectomy (SE; n = 4515) were 2.0%, 5.4%, and 0.1%, respectively. The upper mediastinal LN dissection (P = 0.016) and the higher level of the tracheal resection (P = 0.039) were significantly associated with a higher grade of necrosis in PLCE and TPLE. Overall survival rates were significantly lower in patients with Grade 2 (P = 0.009) and Grade 3 (P = 0.004) than in those with Grade 1. Conclusion The incidence of TBN restricted to P-TBN was lower than previously reported. Maintaining the tracheal blood flow is essential to prevent worsening P-TBN, especially in PLCE and TPLE. Our new P-TBN severity grade may predict the outcome of patients with P-TBN.
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Affiliation(s)
- Makoto Sakai
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of MedicineGunma UniversityMaebashiJapan
| | - Hiroshi Saeki
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of MedicineGunma UniversityMaebashiJapan
| | - Makoto Sohda
- Division of Gastroenterological Surgery, Department of General Surgical Science, Graduate School of MedicineGunma UniversityMaebashiJapan
| | - Mizuki Korematsu
- Department of Head and Neck SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Hiroshi Miyata
- Department of Digestive SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Daizo Murakami
- Department of Otolaryngology‐Head and Neck Surgery, Graduate School of MedicineKumamoto UniversityKumamotoJapan
| | - Yoshifumi Baba
- Department of Gastroenterological Surgery, Graduate School of Medical ScienceKumamoto UniversityKumamotoJapan
| | - Ryo Ishii
- Department of Otolaryngology‐Head and Neck SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Hiroshi Okamoto
- Department of Gastroenterological SurgeryTohoku University Graduate School of MedicineSendaiJapan
| | - Tomotaka Shibata
- Advanced Trauma, Emergency and Critical Care Center/Gastroenterological and Pediatric SurgeryOita University HospitalYufuJapan
| | - Ken Shirabe
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Yasushi Toh
- National Hospital Organization Kyushu Cancer CenterFukuokaJapan
| | - Akihiro Shiotani
- Department of Otolaryngology‐ Head and Neck SurgeryNational Defense Medical CollegeSaitamaJapan
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Wang X, Hu B, Chen J, Xie F, Han D, Zhao Q, Sun H, Fu C, Liu C, Wang Z, Lin H, Huang W. Risk factors of esophageal fistula induced by re-radiotherapy for recurrent esophageal cancer with local primary site. BMC Cancer 2022; 22:207. [PMID: 35209855 PMCID: PMC8876373 DOI: 10.1186/s12885-022-09319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of the present study was to investigate risk factors for esophageal fistula (EF) in patients with recurrent esophageal cancer receiving re-radiotherapy with or without chemotherapy. METHODS We reviewed retrospectively the clinical characters and dosimetric parameters of 96 patients with recurrent esophageal cancer treated with re-radiotherapy in Cancer Hospital Affiliated to Shandong First Medical University between August 2014 and January 2021.Univariate and multivariate logistic regression analyses were provided to determine the risk factors of EF induced by re-radiotherapy. RESULTS The median time interval between two radiotherapy was 23.35 months (range, 4.30 to 238.10 months). EF occurred in 19 patients (19.79%). In univariate analysis, age, T stage, the biologically equivalent dose in the re-radiotherapy, total biologically equivalent dose, hyperfractionated radiotherapy, ulcerative esophageal cancer, the length of tumor and the maximum thickness of tumor had a correlation with the prevalence of EF. In addition, age (HR = 0.170, 95%CI 0.030-0.951, p = 0.044), T stage (HR = 8.369, 95%CI 1.729-40.522, p = 0.008), ulcerative esophageal cancer (HR = 5.810, 95%CI 1.316-25.650, p = 0.020) and the maximum thickness of tumor (HR = 1.314, 95%CI 1.098-1.572, p = 0.003) were risk factors of EF in multivariate logistic regression analysis. CONCLUSIONS The incidence of EF was significantly increased in patients with recurrent esophageal cancer who underwent re-radiotherapy. This study revealed that age, T stage, ulcerative esophageal cancer and the maximum thickness of the tumor were risk factors associated with EF. In clinical work, patients with risk factors for EF ought to be highly concerned and individualized treatment plans should be taken to reduce the occurrence of EF.
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Affiliation(s)
- Xinran Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Bing Hu
- Department of Oncology, Jinxiang people's hospital, Jinxiang, Shandong Province, China
| | - Jinhu Chen
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Feihong Xie
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Dan Han
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Qian Zhao
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Hongfu Sun
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Chengrui Fu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Chengxin Liu
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Zhongtang Wang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Haiqun Lin
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan road, Huaiyin distract, Jinan, 250117, Shandong Province, China
| | - Wei Huang
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan road, Huaiyin distract, Jinan, 250117, Shandong Province, China.
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Kanamori J, Abe S, Kurita D, Ishiyama K, Hirano Y, Oguma J, Oda I, Saito Y, Daiko H. Minimally invasive hybrid surgery: A salvage tumor enucleation for local recurrence of thoracic esophageal carcinoma after definitive chemoradiotherapy. Asian J Endosc Surg 2021; 14:77-80. [PMID: 32633076 DOI: 10.1111/ases.12830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/15/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Abstract
Local recurrence after definitive chemoradiation for esophageal carcinoma is associated with poor outcomes. Although salvage esophagectomy is a standard treatment that offers a chance of long-term survival, the procedure is associated with high morbidity and mortality. Minimally invasive hybrid surgery (MIHS) employs thoracoscopic and esophagoscopic procedures and is generally used to treat benign esophageal submucosal tumors. A 64-year-old man with thoracic esophageal carcinoma experienced local relapse after definitive chemoradiation. He underwent MIHS and was discharged 18 days after surgery with a slight degree of stricture. Pathological findings revealed squamous cell carcinoma with no residual tumor in the resection margins, and the patient remains free from cancer relapse 24 months after surgery. Here, we report the findings in this patient, in whom MIHS was successfully performed as a salvage tumor enucleation for local recurrence of esophageal carcinoma after definitive chemoradiotherapy.
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Affiliation(s)
- Jun Kanamori
- Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Daisuke Kurita
- Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Koshiro Ishiyama
- Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yuki Hirano
- Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Junya Oguma
- Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Ichiro Oda
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyuki Daiko
- Esophageal Surgery Division, National Cancer Center Hospital, Tokyo, Japan
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Patient selection for salvage surgery after definitive chemoradiotherapy in esophageal squamous cell carcinoma. Langenbecks Arch Surg 2020; 405:767-776. [PMID: 32671456 DOI: 10.1007/s00423-020-01935-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE With the widespread use of definitive chemoradiotherapy (dCRT) for esophageal squamous cell carcinoma (ESCC), salvage surgery for recurrence/residual patients became prevalent. However, survival impact of salvage surgery remains obscure at present. METHODS The updated clinical outcomes of salvage surgery were investigated to know its survival impact. Of the 155 ESCC patients who underwent dCRT between 2009 and 2016, we included 85 patients with recurrence or residual disease. The median follow-up was 65 months. RESULTS Of the 85 patients with progression disease, there were 42 and 43 patients of recurrence and residual disease, respectively. Salvage surgery was performed in 27 patients after dCRT, including 15 patients who underwent salvage esophagectomy. The 5-year overall survival (OS) of salvage surgery and otherwise patients was 66.1% and 14.5%, and the patients with salvage surgery had a significantly better prognosis (p < 0.0001). In the 15 patients who underwent salvage esophagectomy, residual disease, lymph node metastasis-positive (ycN+) after dCRT, and pathological lymph node metastasis-positive (ypN+) were significantly associated with poor prognosis (p = 0.0492, p = 0.0006, p = 0.0276), and the 5-year OS rates for the ycN/ypN combinations were 90%, 33.3%, and 0% in ycN-/ypN-, ycN+/ypN-, and ycN+/ypN+ patients, respectively (p = 0.0026). In a multivariate analysis, ycN+ was an independent poor prognostic factor (HR 13.6, 95% CI 1.65-286.8, p = 0.0154). CONCLUSIONS Survival impact of salvage surgery after dCRT is robust, and lymph node metastasis after dCRT may help determine the indication for salvage esophagectomy.
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Faiz Z, Dijksterhuis WPM, Burgerhof JGM, Muijs CT, Mul VEM, Wijnhoven BPL, Smit JK, Plukker JTM. A meta-analysis on salvage surgery as a potentially curative procedure in patients with isolated local recurrent or persistent esophageal cancer after chemoradiotherapy. Eur J Surg Oncol 2018; 45:931-940. [PMID: 30447937 DOI: 10.1016/j.ejso.2018.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/01/2018] [Accepted: 11/02/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Isolated local recurrent or persistent esophageal cancer (EC) after curative intended definitive (dCRT) or neoadjuvant chemoradiotherapy (nCRT) with initially omitted surgery, is a potential indication for salvage surgery. We aimed to evaluate safety and efficacy of salvage surgery in these patients. MATERIAL AND METHODS A systematic literature search following PRISMA guidelines was performed using databases of PubMed/Medline. All included studies were performed in patients with persistent or recurrent EC after initial treatment with dCRT or nCRT, between 2007 and 2017. Survival analysis was performed with an inverse-variance weighting method. RESULTS Of the 278 identified studies, 28 were eligible, including a total of 1076 patients. Postoperative complications after salvage esophagectomy were significantly more common among patients with isolated persistent than in those with locoregional recurrent EC, including respiratory (36.6% versus 22.7%; difference in proportion 10.9 with 95% confidence interval (CI) [3.1; 18.7]) and cardiovascular complications (10.4% versus 4.5%; difference in proportion 5.9 with 95% CI [1.5; 10.2]). The pooled estimated 30- and 90-day mortality was 2.6% [1.6; 3.6] and 8.0% [6.3; 9.8], respectively. The pooled estimated 3-year and 5-year overall survival (OS) were 39.0% (95% CI: [35.8; 42.2]) and 19.4% [95% CI:16.5; 22.4], respectively. Patients with isolated persistent or recurrent EC after initial CRT had similar 5-year OS (14.0% versus 19.7%, difference in proportion -5.7, 95% CI [-13.7; 2.3]). CONCLUSIONS Salvage surgery is a potentially curative procedure in patients with locally recurrent or persistent esophageal cancer and can be performed safely after definitive or neoadjuvant chemoradiotherapy when surgery was initially omitted.
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Affiliation(s)
- Z Faiz
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - W P M Dijksterhuis
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - C T Muijs
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - V E M Mul
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - B P L Wijnhoven
- Department of Surgery, University of Rotterdam, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - J K Smit
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Surgery, Ziekenhuis Groep Twente, Almelo, the Netherlands
| | - J T M Plukker
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
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Nakajima M, Muroi H, Kikuchi M, Yamaguchi S, Sasaki K, Tsuchioka T, Takei Y, Shibasaki I, Fukuda H, Kato H. Salvage esophagectomy combined with partial aortic wall resection following thoracic endovascular aortic repair. Gen Thorac Cardiovasc Surg 2018; 66:736-743. [DOI: 10.1007/s11748-018-1013-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/08/2018] [Indexed: 02/08/2023]
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Nakano R, Ohira M, Kobayashi T, Imaoka Y, Mashima H, Yamaguchi M, Honmyo N, Okimoto S, Hamaoka M, Shimizu S, Kuroda S, Tahara H, Ide K, Ohdan H. Independent risk factors that predict bile leakage after hepatectomy for hepatocellular carcinoma: Cohort study. Int J Surg 2018; 57:1-7. [PMID: 30036692 DOI: 10.1016/j.ijsu.2018.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/06/2018] [Accepted: 07/16/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Bile leakage is a major cause of morbidity after hepatectomy. This study aimed to identify the predictive factors for bile leakage after hepatectomy. MATERIALS AND METHODS Between January 2011 and December 2016, 556 patients underwent a liver resection for hepatocellular carcinoma with curative intent, and were enrolled to participate in this study. The incidence of postoperative bile leakage (POBL) was determined and the predictive factors for POBL were identified using univariate and multivariate analysis. RESULTS POBLs occurred in 28 patients (5.0%). The multivariate analysis identified a history of stereotactic body radiotherapy, a body mass index <20 kg/m2, Child-Pugh class B cirrhosis, a central hepatectomy, and an operation time ≥375 min as risk factors that were associated with POBL. When the study cohort was grouped according to the number of the predictive factors present, the incidence of POBL increased as the number of the extant independent predictive factors increased. The POBL rate was 45.0% in patients with ≥3 predictive factors. CONCLUSION We determined that POBL was associated with operative mortality and identified five independent predictive factors associated with POBL. Risk stratification using these predictive factors may be useful for identifying patients at a high risk of POBL.
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Affiliation(s)
- Ryosuke Nakano
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masahiro Ohira
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan; Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yuki Imaoka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroaki Mashima
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Megumi Yamaguchi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Naruhiko Honmyo
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Sho Okimoto
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Michinori Hamaoka
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Seiichi Shimizu
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroyuki Tahara
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kentaro Ide
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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12
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Hayami M, Watanabe M, Ishizuka N, Mine S, Imamura Y, Okamura A, Kurogochi T, Yamashita K. Prognostic impact of postoperative pulmonary complications following salvage esophagectomy after definitive chemoradiotherapy. J Surg Oncol 2017; 117:1251-1259. [PMID: 29205358 DOI: 10.1002/jso.24941] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/05/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Postoperative complications after esophagectomy for esophageal cancer have a negative effect on patients' survival. Although postoperative complications are more frequently observed after salvage esophagectomy than after planned esophagectomy, the effects of postoperative complications on long-term oncologic outcomes after salvage esophagectomy remain unclear. METHODS This retrospective study of 70 esophageal cancer patients after definitive chemoradiotherapy (dCRT) compared long-term outcomes between those with and without complications. The association between morbidity and overall survival (OS) was evaluated by a Cox regression analysis. To identify the risk factors for pulmonary complications, logistic regression analysis was carried out. RESULTS Postoperative complications occurred in 42 (60.0%) patients. Pulmonary complications and anastomotic leakage occurred in 23 (32.9%) and 9 (12.9%) patients, respectively. Overall complications and anastomotic leakage did not affect long-term outcomes. Survival was significantly worse for patients with pulmonary complications. Radiation dose (<60 Gy), response to dCRT (complete), ypStage (0-II), residual disease (R0), and pulmonary complications (negative) were independent factors related to a favorable OS. BMI (<20 kg/m2 ), ASA-PS (2-3), and radiation dose (>60 Gy) were significant factors affecting the occurrence of pulmonary complications. CONCLUSIONS Development of postoperative pulmonary complications was independently associated with poor prognosis in patients who underwent salvage esophagectomy after dCRT.
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Affiliation(s)
- Masaru Hayami
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Naoki Ishizuka
- Department of Clinical Trial Planning and Management, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinji Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yu Imamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akihiko Okamura
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takanori Kurogochi
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Wang DB, Sun ZY, Deng LM, Zhu DQ, Xia HG, Zhu PZ. Neoadjuvant Chemoradiotherapy Improving Survival Outcomes for Esophageal Carcinoma: An Updated Meta-analysis. Chin Med J (Engl) 2016; 129:2974-2982. [PMID: 27958230 PMCID: PMC5198533 DOI: 10.4103/0366-6999.195464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The effectiveness of neoadjuvant chemoradiotherapy (NCRT) treatment for patients with esophageal carcinoma (EC) remains controversial. The aim of this study was to compare the effect of NCRT followed by surgery (NCRTS) with surgery alone (SA) for EC. METHODS The PubMed, EMBASE, and the Cochrane Library databases were electronically searched up to August 2015 for all the published studies that investigated EC patients receiving either NCRTS or SA, and the reference lists were also manually examined for the eligible studies. The risk ratio (RR) with 95% confidence intervals (CI s) as effective size was determined to assess the 1-, 3-, 5-year survival rates (SRs), postoperative morbidity, and postoperative mortality. Heterogeneity was determined using the Q-test. The Begg's test and Egger's test were used for assessing any potential publication bias. RESULTS Of 1120 identified studies, 16 eligible studies were included in this analysis (involving 2549 patients). Overall, the pooled results suggested that NCRTS was associated with significantly improved 1-year (RR: 1.07, 95% CI: 1.02-1.13), 3-year (RR: 1.26, 95% CI: 1.14-1.39), and 5-year (RR: 1.36, 95% CI: 1.18-1.56) SRs. However, the results also indicated that NCRTS had no or little effect on postoperative morbidity (RR: 0.93, 95% CI: 0.82-1.05) and postoperative mortality (RR: 1.17, 95% CI: 0.56-2.44). CONCLUSIONS Compared with SA, NCRTS can increase 1-, 3-, and 5-year SRs in patients with EC.
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Affiliation(s)
- Dong-Bin Wang
- Department of Cardiothoracic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Zhong-Yi Sun
- Department of Cardiothoracic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Li-Min Deng
- Department of Cardiothoracic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - De-Qing Zhu
- Department of Cardiothoracic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Hong-Gang Xia
- Department of Cardiothoracic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Peng-Zhi Zhu
- Department of Cardiothoracic Surgery, Tianjin Hospital, Tianjin 300211, China
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Kondo S, Tajika M, Tanaka T, Kodaira T, Mizuno N, Hara K, Hijioka S, Imaoka H, Goto H, Yamao K, Niwa Y. Prognostic factors for salvage endoscopic resection for esophageal squamous cell carcinoma after chemoradiotherapy or radiotherapy alone. Endosc Int Open 2016; 4:E841-8. [PMID: 27540571 PMCID: PMC4988842 DOI: 10.1055/s-0042-109609] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/23/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND STUDY AIMS Endoscopic resection is one treatment option for residual or locally recurrent esophageal cancer after definitive chemoradiotherapy or radiotherapy alone. However, little is known about the clinical benefit of salvage endoscopic resection for these lesions. Therefore, the effectiveness and prognostic factors of salvage endoscopic resection were investigated. PATIENTS AND METHODS A total of 37 patients with esophageal squamous cell carcinoma (SCC) who underwent salvage endoscopic resection after definitive chemoradiotherapy or radiotherapy alone were reviewed. The method of salvage endoscopic resection was endoscopic mucosal resection using a cap (EMR-C), strip biopsy, or endoscopic submucosal dissection. The effectiveness and prognostic factors of salvage endoscopic resection were retrospectively analyzed. RESULTS A total of 37 patients with 49 lesions underwent salvage endoscopic resection. Baseline clinical stages were I in 23 patients, II in 3 patients, III in 9 patients, and IV in 2 patients. The number of locoregional recurrences and residual lesions were 35 and 14, respectively. The curative en bloc resection rate was 53.1 % (26/49). The total incidence of complications was 18.9 % (7/37); all were successfully managed conservatively. The 3-year and 5-year overall survival rates were 72.9 % and 53.3 %, respectively, with a median follow-up period of 54 months. Baseline clinical T1 - 2 and N0 were significant factors for good prognosis in terms of overall survival on univariate analysis. CONCLUSIONS Salvage endoscopic resection, especially EMR-C, is a safe and feasible procedure to control residual or recurrent superficial esophageal SCC after definitive chemoradiotherapy or radiotherapy alone. The present results showed that baseline clinical T1 - 2 and N0 before chemoradiotherapy or radiotherapy were significant prognostic factors.
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Affiliation(s)
- Shinya Kondo
- Department of Gastroenterology, Aichi Cancer Center Aichi Hospital, Aichi, Japan,Department of Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan,Corresponding author Shinya Kondo, MD Department of GastroenterologyAichi Cancer Center Aichi Hospital18 KuriyadoKakemachiOkazakiAichi 444-0011Japan+81-564-216467
| | - Masahiro Tajika
- Department of Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
| | - Tsutomu Tanaka
- Department of Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Kazuo Hara
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Susumu Hijioka
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Hiroshi Imaoka
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Hidemi Goto
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Yamao
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Yasumasa Niwa
- Department of Endoscopy, Aichi Cancer Center Hospital, Aichi, Japan
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Kim HW, Kim JH, Lee IJ, Kim JW, Lee YC, Lee CG, Park JJ, Youn YH, Park H. Local control may be the key in improving treatment outcomes of esophageal squamous cell carcinoma undergoing concurrent chemoradiation. Digestion 2015; 90:254-60. [PMID: 25531173 DOI: 10.1159/000368983] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 10/10/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIM Little is known about the patterns of treatment failure following definitive chemoradiotherapy (CCRT), especially in esophageal squamous cell carcinoma (SCC). We evaluated definitive CCRT failure patterns and determined the predictive factors for treatment response in esophageal SCC. METHODS We evaluated 136 consecutive patients with esophageal SCC treated with definitive CCRT. We evaluated the factors associated with complete remission (CR) after CCRT and analyzed the pattern of treatment failure of recurred patients and incomplete remission patients. The failures were categorized as either within (locoregional failure) or outside the radiation field (out-field failure). RESULTS Fifty-seven patients achieved CR after CCRT. Consolidation chemotherapy was significantly associated with CR. Only 4 (7.0%) patients had CR after CCRT in patients with M1a node (Celiac or subclavian lymph nodes involvement by 6th AJCC). During follow-up, 74 patients (54.4%) experienced locoregional failure, 26 (19.1%) out-field failure, and 35 (25.7%) no failure. Esophageal obstruction prior to CCRT, residual tumor according to the first follow-up endoscopy, and poor follow-up computed tomography responses were significantly associated with locoregional failure. CONCLUSION Approximately 70% of treatment failures were local failures. Future therapeutic strategies need to focus on improving local control to increase treatment outcomes of CCRT.
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Affiliation(s)
- Hae Won Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Watanabe M, Mine S, Nishida K, Yamada K, Shigaki H, Matsumoto A, Sano T. Salvage Esophagectomy After Definitive Chemoradiotherapy for Patients with Esophageal Squamous Cell Carcinoma: Who Really Benefits from this High-Risk Surgery? Ann Surg Oncol 2015; 22:4438-44. [PMID: 25862582 DOI: 10.1245/s10434-015-4556-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to identify good candidates for salvage esophagectomy after definitive chemoradiotherapy (dCRT), based on safety and survival. METHODS Sixty-three patients who underwent salvage esophagectomy, after dCRT, at the Cancer Institute Hospital, Tokyo, Japan, between 1988 and 2013, were retrospectively analyzed. Short-term outcomes were evaluated by reviewing postoperative complications, length of postoperative hospital stay, and mortality. Survival rates were calculated using the Kaplan-Meier method, and statistical significance was determined using the log-rank test. The Cox proportional hazards model was used for univariate and multivariate analyses of overall survival. Univariate logistic regression analysis was used to identify factors related to R0 resection. RESULTS Postoperative complications occurred in 41 patients (65.1 %), and the mortality rate was 7.9 %. In-hospital deaths did not occur among patients with less advanced tumors prior to dCRT (cT1-2 and cN0), or among those who had previously achieved a complete response (CR); the 3- and 5-year overall survival rates were 29.8 % and 15.0 %, respectively. Univariate analysis revealed that residual disease, tumor depth, dCRT response, lymph node metastasis, and time to relapse were significant factors affecting overall survival. Multivariate analysis demonstrated that R0 resection and ypT0-2 tumors were significant, favorable prognostic factors in patients undergoing salvage esophagectomy. In addition, cT1-2 tumors, initially resectable tumors, ycT1-2 tumors, and relapse after CR were factors predicting R0 resection. CONCLUSIONS Based on both short- and long-term outcomes, patients with pretreatment or preoperative T1-2 tumors and those with relapse after CR are good candidates for salvage esophagectomy.
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Affiliation(s)
- Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
| | - Shinji Mine
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koujiro Nishida
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazuhiko Yamada
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hironobu Shigaki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Akira Matsumoto
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Sano
- Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
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Definitive chemoradiotherapy and salvage esophagectomy for esophageal cancer associated with multiple lung metastases: a case report. Int Surg 2014; 99:640-4. [PMID: 25216435 DOI: 10.9738/intsurg-d-13-00123.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The prognosis of esophageal cancer with distant metastasis is dismal. We report a 70-year-old man with esophageal cancer and multiple lung and lymph node metastases. Complete response was achieved following definitive chemoradiotherapy. Twenty-four months after the initial chemoradiotherapy, local recurrence was detected but there was no evidence of distant metastasis. Therefore, the patient underwent salvage esophagectomy. The surgery was well tolerated without any postoperative complications. The patient is still alive 48 months after the salvage surgery. Our experience suggests that salvage esophagectomy is an important component of multimodal therapy for the recurrence of esophageal cancer.
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Ito N, Iwaya T, Ikeda K, Kimura Y, Akiyama Y, Konosu M, Ishida K, Fujiwara H, Otsuka K, Nitta H, Kashiwaba M, Koeda K, Nishizuka S, Mizuno M, Sasaki A, Wakabayashi G. Hyperglycemia 3 days after esophageal cancer surgery is associated with an increased risk of postoperative infection. J Gastrointest Surg 2014; 18:1547-56. [PMID: 24992996 DOI: 10.1007/s11605-014-2587-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/24/2014] [Indexed: 01/31/2023]
Abstract
PURPOSE Postoperative hyperglycemia is associated with infectious complications after various types of surgery. Our objective was to determine whether postoperative blood glucose levels up to 1 week after highly invasive esophageal cancer surgery are associated with the incidence of postoperative infections (POIs). METHODS We conducted a retrospective chart review of 109 consecutive thoracic esophageal squamous cell cancer patients who underwent invasive esophagectomy with thoracotomy and laparotomy. The incidence of postoperative POIs and risk factors for POIs, including postoperative blood glucose levels, were evaluated. RESULTS Of the 109 patients, 37 (34.0 %) developed POIs. Clinically, 73.0 % of the POIs became evident on or after postoperative day 4 (median, 5.25 days; interquartile range, 3.00-9.25 days). On and after postoperative day 3, chronological changes in blood glucose levels were significantly different between two groups of patients with or without POIs, as indicated by repeated measures ANOVA (P = 0.006). Multivariate logistic regression analysis results showed that an increased blood glucose concentration on postoperative day 3 was a significant risk factor for POIs. CONCLUSIONS Our findings suggested that postoperative hyperglycemia on postoperative day 3 was a predictive factor of POIs after highly invasive esophageal cancer surgery.
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Affiliation(s)
- Naoko Ito
- Department of Surgery, Iwate Medical University, School of Medicine, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
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Karimata H, Shimoji H, Nishimaki T. Clinicopathological factors predicting R0 resection and long-term survival after esophagectomy in patients with T4 esophageal cancer undergoing induction chemotherapy or chemoradiotherapy. Surg Today 2014; 45:479-86. [PMID: 25059344 DOI: 10.1007/s00595-014-0980-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 06/02/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE To identify clinicopathological factors predicting R0 resection and long-term survival after esophagectomy in patients with T4 esophageal cancer following induction chemotherapy or chemoradiotherapy. METHODS Of 48 patients with T4 esophageal cancer who underwent induction treatment, 30 underwent R0 esophagectomy. The factors predicting R0 resection and prognostic indicators were assessed in the 48 and 30 patients, respectively, using univariate and multivariate analyses. RESULTS In the univariate analyses, the primary tumor response, improvement of dysphagia, the post-induction therapy Glasgow Prognostic Score, an early tumor response and the post-induction therapy serum albumin and C-reactive protein levels were significantly correlated with R0 resection. Multivariate logistic regression analyses revealed that the response status and improvement of dysphagia were independent predictors of R0 resection. The univariate analyses identified a yp-T classification (yp-T0/1 vs. yp-T2/3/4), yp-nodal status and the number of pathologically positive nodes post-therapy (≤ 1 vs. ≥ 2) as significant prognostic factors. The multivariate analysis revealed that the number of pathologically positive nodes was the only significant independent prognostic indicator. CONCLUSION Patients showing an early tumor response to induction treatment and improvement of dysphagia may be appropriate candidates for esophagectomy, and individualized postoperative management strategies should be developed for patients with initially unresectable T4 esophageal cancer who have ≥ 2 positive nodes post-treatment.
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Affiliation(s)
- Hiroyuki Karimata
- Department of Digestive and General Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
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Nakajima M, Domeki Y, Satomura H, Takahashi M, Sugawara A, Muroi H, Sasaki K, Yamaguchi S, Miyazaki T, Kuwano H, Kato H. Salvage lymphadenectomy for recurrent esophageal cancer after chemoradiotherapy. Int Surg 2014; 99:452-7. [PMID: 25058783 PMCID: PMC4114379 DOI: 10.9738/intsurg-d-13-00261.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Although salvage esophagectomies are widely performed, reports on salvage lymphadenectomy (SL) are few. We review our SL cases to clarify the indications. Fifty-five patients with esophageal cancer underwent chemoradiotherapy or radiotherapy, including 3 patients with single lymph node (LN) recurrences and one with allochronic double cervical node recurrence. Our department removed 5 recurrent LNs from these 4 patients. In Case 1, right supraclavicular LN was judged to be metastatic and R0 resection was carried out; he is alive without recurrence. In Case 2, we found, allochronically, metastases in his left cervical paraesophageal LN and left supraclavicular LN; residual tumors were R1 in both lesions. He is alive despite esophageal recurrence. In Case 3, a lymphadenectomy was performed on his thoracic para-aortic LN; however, tumor was removed incompletely, and he died 4 months after SL from disease progression. In Case 4, a subcarinal LN was thought to be metastatic, and was removed but no malignant tissues detected. He died 17 months after SL from pneumonia. Our experiences suggest that some patients survive relatively long with SL. Moreover, molecular examination of resected lesions could guide subsequent therapies. SL might be more widely used for these patients if not otherwise contraindicated.
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Affiliation(s)
- Masanobu Nakajima
- Department of Surgery I, Dokkyo Medical University, Mibu, Shimotsuga-gun, Tochigi, Japan
| | - Yasushi Domeki
- Department of Surgery I, Dokkyo Medical University, Mibu, Shimotsuga-gun, Tochigi, Japan
| | - Hitoshi Satomura
- Department of Surgery I, Dokkyo Medical University, Mibu, Shimotsuga-gun, Tochigi, Japan
| | - Masakazu Takahashi
- Department of Surgery I, Dokkyo Medical University, Mibu, Shimotsuga-gun, Tochigi, Japan
| | - Akira Sugawara
- Department of Surgery I, Dokkyo Medical University, Mibu, Shimotsuga-gun, Tochigi, Japan
| | - Hiroto Muroi
- Department of Surgery I, Dokkyo Medical University, Mibu, Shimotsuga-gun, Tochigi, Japan
| | - Kinro Sasaki
- Department of Surgery I, Dokkyo Medical University, Mibu, Shimotsuga-gun, Tochigi, Japan
| | - Satoru Yamaguchi
- Department of Surgery I, Dokkyo Medical University, Mibu, Shimotsuga-gun, Tochigi, Japan
| | - Tatsuya Miyazaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroyuki Kato
- Department of Surgery I, Dokkyo Medical University, Mibu, Shimotsuga-gun, Tochigi, Japan
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Watanabe M, Mine S, Yamada K, Shigaki H, Baba Y, Yoshida N, Kajiyama K, Yamamoto N, Sano T, Baba H. Outcomes of lymphadenectomy for lymph node recurrence after esophagectomy or definitive chemoradiotherapy for squamous cell carcinoma of the esophagus. Gen Thorac Cardiovasc Surg 2014; 62:685-92. [PMID: 24965711 DOI: 10.1007/s11748-014-0444-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 06/20/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to determine the significance of lymphadenectomy for recurrence after treatment for esophageal squamous cell carcinoma. METHODS Short- and long-term outcomes of 24 patients who underwent lymphadenectomy for recurrence in 3 hospitals between April 2004 and March 2013 were retrospectively analyzed. There were 17 cases with lymph node recurrence after esophagectomy (11 cervical, 4 mediastinal, and 2 abdominal node recurrences) and 7 cases with remnant or recurrent lymphatic diseases after definitive chemoradiotherapy (3 cervical, 1 mediastinal, and 3 abdominal node recurrences). RESULTS Three minor complications were observed among 24 patients and the median postoperative hospital stay was 7 days. The 3-year progression-free and overall survivals of patients who underwent secondary lymphadenectomy for recurrence after esophagectomy were 51.5 and 75.5 %, respectively. The overall survival of patients with cervical node recurrence was significantly better than that of patients with mediastinal or abdominal node recurrence in this group (P = 0.0097). The median progression-free and overall survivals of patients who underwent salvage lymphadenectomy after definitive chemoradiotherapy were 2 and 15 months, respectively. Although only 1 patient experienced local recurrence after secondary lymphadenectomy, locoregional failures occurred in 6 of 7 patients who underwent salvage lymphadenectomy after definitive chemoradiotherapy. CONCLUSION Secondary or salvage lymphadenectomy can be performed safely in the selected patients. Secondary lymphadenectomy achieves locoregional disease control and results in a favorable long-term outcome, particularly for cervical node recurrence. Further large-scale cohort studies are needed to determine the prognostic significance of salvage lymphadenectomy after definitive chemoradiotherapy.
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Affiliation(s)
- Masayuki Watanabe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan,
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22
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Wang S, Tachimori Y, Hokamura N, Igaki H, Kishino T, Nakazato H. A Retrospective Study on Nonmalignant Airway Erosion After Right Transthoracic Subtotal Esophagectomy: Incidence, Diagnosis, Therapy, and Risk Factors. Ann Thorac Surg 2014; 97:467-73. [DOI: 10.1016/j.athoracsur.2013.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 08/27/2013] [Accepted: 10/04/2013] [Indexed: 11/27/2022]
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Wang S, Tachimori Y, Hokamura N, Igaki H, Nakazato H, Kishino T. Prognostic analysis of salvage esophagectomy after definitive chemoradiotherapy for esophageal squamous cell carcinoma: the importance of lymphadenectomy. J Thorac Cardiovasc Surg 2014; 147:1805-11. [PMID: 24521950 DOI: 10.1016/j.jtcvs.2013.12.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The objective of this study was to review the prognostic factors for increased survival after salvage esophagectomy after definitive chemoradiotherapy for esophageal squamous carcinoma and determine the importance of lymphadenectomy from a prognostic view. METHODS Clinical data for all patients from January 1999 to December 2012 who underwent salvage esophagectomy for residual tumor or tumor recurrence after definitive chemoradiotherapy were retrospectively collected. Survival was determined and prognostic factors were analyzed with univariate and multivariate analyses. RESULTS Survival after 1, 3, and 5 years postoperatively was 74.4%, 39.8%, and 29.5%, respectively. The independent predictive factors for increased postoperative survival were tumor recurrence rather than residual tumor as the indication for salvage surgery (P < .001; odds ratio [OR], 0.292); complete tumor resection (P < .001; OR, 4.520); N category (P = .089; OR, 1.304); M category (P = .081; OR, 2.215), and total mediastinal dissection with 15 or more dissected mediastinal lymph nodes (P = .034; OR, 0.546). CONCLUSIONS Salvage indications of recurrence, earlier disease, and complete tumor resection are related to longer survival. The total area of mediastinal dissection with a sufficient number of dissected mediastinal lymph nodes improves survival. Additional neck dissection does not add benefit. The optimal procedure for lymph node dissection in salvage esophagectomy should be established in future studies.
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Affiliation(s)
- Shaohua Wang
- Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan; Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuji Tachimori
- Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
| | - Nobukazu Hokamura
- Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroyasu Igaki
- Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Hidetsugu Nakazato
- Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takayoshi Kishino
- Division of Esophageal Surgery, Department of Surgery, National Cancer Center Hospital, Tokyo, Japan
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Wada T, Takeuchi H, Kawakubo H, Nakamura R, Oyama T, Takahashi T, Wada N, Saikawa Y, Omori T, Jinzaki M, Kuribayashi S, Kitagawa Y. Clinical utility of preoperative evaluation of bronchial arteries by three-dimensional computed tomographic angiography for esophageal cancer surgery. Dis Esophagus 2013; 26:616-22. [PMID: 23237474 DOI: 10.1111/dote.12012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
An identification of bronchial arteries (BAs) is critical in esophageal cancer surgery to avoid tracheobronchial ischemia and unexpected massive bleeding during surgical procedure particularly in thoracoscopic video-assisted esophagectomy. We describe the efficacy of three-dimensional computed tomographic angiography (3D-CTA) of BAs for preoperative evaluation in esophageal cancer surgery. Sixty-four patients with esophageal cancer who preoperatively underwent multidetector computed tomography examination were included in this study. We evaluated the number, origin, and intraoperative preservation rate of BAs, and we compared the number of thoracic paratracheal lymph nodes harvested between two groups comprising patients who either underwent preoperative 3D-CTA of BAs (3D-CTA group) or did not (non-3D-CTA group). The right and left BAs were preoperatively identified in 62 patients (97%) and 55 patients (86%), respectively, using 3D-CTA. In 34 patients (53%), the right BA originated as a common trunk with the right intercostal artery. In 48 patients (75%), the left BA originated from the descending aorta as a single or double branch. Some anomalies such as the right BA originated from the left subclavian artery were observed. In all patients, either the right or the left BA was preserved. The number of harvested lymph nodes in left side of paratrachea was significantly increased in 3D-CTA group, than those in non-3D-CTA group. 3D-CTA clearly revealed BA anatomy, contributing to BA preservation and safe and precise lymphadenectomy in esophageal cancer surgery. 3D-CTA of BAs is useful for preoperative evaluation in esophageal cancer surgery.
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Affiliation(s)
- T Wada
- Department of Surgery, School of Medicine, Keio University, Tokyo, Japan
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25
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Nakajima M, Kato H. Treatment options for esophageal squamous cell carcinoma. Expert Opin Pharmacother 2013; 14:1345-54. [DOI: 10.1517/14656566.2013.801454] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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26
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Kato H, Nakajima M. Treatments for esophageal cancer: a review. Gen Thorac Cardiovasc Surg 2013; 61:330-5. [PMID: 23568356 DOI: 10.1007/s11748-013-0246-0] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Indexed: 01/15/2023]
Abstract
Esophageal cancer is the eighth most common form of cancer worldwide. The treatments for esophageal cancer depend on its etiology. For mucosal cancer, endoscopic mucosal resection and endoscopic submucosal dissection are standard, while for locally advanced cancer, esophagectomy remains the mainstay. The three most common techniques for thoracic esophagectomy are the transhiatal approach, the Ivor Lewis esophagectomy (right thoracotomy and laparotomy), and the McKeown technique (right thoracotomy followed by laparotomy and neck incision with cervical anastomosis). Surgery for carcinoma of the cervical esophagus requires an extensive procedure with laryngectomy in many cases. When the tumor is more advanced, neoadjuvant chemotherapy or neoadjuvant chemoradiotherapy is added. The theoretical advantages of adding chemotherapy to the treatment of esophageal cancer are potential tumor down-staging prior to surgery, as well as targeting micrometastases and, thus, decreasing the risk of distant metastasis. Cisplatin- and 5-fluorouracil-based regimes are used worldwide. Chemoradiotherapy is the standard for unresectable esophageal cancer and could also be considered as an option for resectable tumors. For patients who are medically or technically inoperable, concurrent chemoradiotherapy should be the standard of care. Although neoadjuvant chemoradiotherapy followed by surgery or salvage surgery after definitive chemoradiotherapy is a practical treatment; judicious patient selection is crucial. It is important to have a thorough understanding of these therapeutic modalities to assist in this endeavor.
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Affiliation(s)
- Hiroyuki Kato
- Department of Surgery I, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga-gun, Tochigi, 321-0293, Japan
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Abstract
Oesophageal carcinoma is one of the most virulent malignant diseases and a major cause of cancer-related deaths worldwide. Diagnosis and accuracy of pretreatment staging have substantially improved throughout the past three decades. Therapy is challenging and the optimal approach is still debated. Oesophagectomy is considered to be the procedure of choice in patients with operable oesophageal cancer. Endoscopic measures and limited surgical procedures provide an alternative in patients with early carcinomas confined to the oesophageal mucosa. Chemotherapy and radiotherapy or concurrent chemoradiotherapy are also frequently applied, either as definitive treatment or as neoadjuvant therapy within multimodal approaches. The question of whether multimodal treatment offers improved results has been the focus of many studies since the 1990s. Although results are discordant and even some meta-analyses remain inconclusive, it is now widely accepted that multimodal therapy leads to a modest survival benefit. The role of minimally invasive oesophagectomy is not yet defined. Endoscopic stent insertion, radiotherapy and other palliative measures provide relief of tumour-related symptoms in advanced, unresectable tumour stages.
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28
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Kim YS, Lee CG, Kim KH, Kim T, Lee J, Cho Y, Koom WS. Re-irradiation of recurrent esophageal cancer after primary definitive radiotherapy. Radiat Oncol J 2012; 30:182-8. [PMID: 23346537 PMCID: PMC3546286 DOI: 10.3857/roj.2012.30.4.182] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/10/2012] [Accepted: 10/22/2012] [Indexed: 01/29/2023] Open
Abstract
PURPOSE For recurrent esophageal cancer after primary definitive radiotherapy, no general treatment guidelines are available. We evaluated the toxicities and clinical outcomes of re-irradiation (re-RT) for recurrent esophageal cancer. MATERIALS AND METHODS We analyzed 10 patients with recurrent esophageal cancer treated with re-RT after primary definitive radiotherapy. The median time interval between primary radiotherapy and re-RT was 15.6 months (range, 4.8 to 36.4 months). The total dose of primary radiotherapy was a median of 50.4 Gy (range, 50.4 to 63.0 Gy). The total dose of re-RT was a median of 46.5 Gy (range, 44.0 to 50.4 Gy). RESULTS The median follow-up period was 4.9 months (range, 2.6 to 11.4 months). The tumor response at 3 months after the end of re-RT was complete response (n = 2), partial response (n = 1), stable disease (n = 2), and progressive disease (n = 5). Grade 5 tracheoesophageal fistula developed in three patients. The time interval between primary radiotherapy and re-RT was less than 12 months in two of these three patients. Late toxicities included grade 1 dysphagia (n = 1). CONCLUSION Re-RT of recurrent esophageal cancer after primary radiotherapy can cause severe toxicity.
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Affiliation(s)
- Young Suk Kim
- Department of Radiation Oncology, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea
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29
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Chen Y, Lu Y, Wang Y, Yang H, Xia Y, Chen M, Song H, Li T, Li D, Wang J, Li S, Wang J. Comparison of salvage chemoradiation versus salvage surgery for recurrent esophageal squamous cell carcinoma after definitive radiochemotherapy or radiotherapy alone. Dis Esophagus 2012; 27:134-40. [PMID: 23088212 DOI: 10.1111/j.1442-2050.2012.01440.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A consensus treatment strategy for esophageal squamous cell carcinoma (ESCC) patients who recur after definitive radiochemotherapy/radiotherapy has not been established. This study compared the outcomes in ESCC patients who underwent salvage surgery, salvage chemoradiation (CRT) or best supportive care (BSC) for local recurrence. Ninety-five patients with clinical stage I to III ESCC who had completely responded to the initial definitive radiochemotherapy or radiotherapy alone and developed local recurrence were enrolled in this study. Fifty-one of them received salvage esophagectomy, and R0 resection was performed in 41 patients, 36 underwent salvage CRT, and the remaining eight patients received BSC only. The 5-year overall survival was 4.6% for the 87 patients receiving salvage surgery or CRT, while all patients in the BSC group died within 12.0 months, the difference was statistically significant (P = 0.018). The 1-, 3-, 5-year survival rates in the salvage surgery and salvage CRT groups were 45.1%, 20.0%, 6.9% and 51.7%, 12.2%, 3.1%, respectively, there was no difference of overall survival between the two groups (P = 0.697). Patients also presented with lymph node relapse had inferior survival compared to those with isolated local tumor recurrence after salvage therapy. In the salvage surgery group, infections occurred in eight patients, and three developed anastomotic leakage. In the salvage CRT group, grade 2-4 esophagitis and radiation pneumonitis was observed in 19 and 3 patients, respectively. Seven patients (19.4%) developed esophagotracheal fistula or esophageal perforation. This study of salvage CRT versus salvage surgery for recurrent ESCC after definitive radiochemotherapy or radiotherapy alone did not demonstrate a statistically significant survival difference, but the frequency of complications including esophagotracheal fistula and esophageal perforation following salvage CRT was high.
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Affiliation(s)
- Y Chen
- Division of Thoracic Oncology, West China Hospital, West China School of Clinical Medicine, Sichuan University, Chengdu, China; Division of Radiation Oncology, Zhengzhou University Affiliated Tumor Hospital, Henan Tumor Hospital, Zhengzhou, China
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30
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Treatment of Resectable Esophageal Cancer: Indications and Long-term Results. Updates Surg 2012. [DOI: 10.1007/978-88-470-2330-7_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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