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Waiting to Operate: The Risk of Salvage Esophagectomy.
Boerner, Thomas; Harrington, Caitlin; Tan, Kay See; Adusumilli, Prasad S; Bains, Manjit S; Bott, Matthew J; Downey, Robert J; Huang, James; Ilson, David H; Isbell, James M; Janjigian, Yelena Y; Park, Bernard J; Rocco, Gaetano; Rusch, Valerie W; Sihag, Smita; Wu, Abraham J; Jones, David R; Molena, Daniela.
Affiliation
  • Boerner T; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Harrington C; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Tan KS; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Adusumilli PS; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Bains MS; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Bott MJ; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Downey RJ; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Huang J; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Ilson DH; Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Isbell JM; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Janjigian YY; Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Park BJ; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Rocco G; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Rusch VW; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Sihag S; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Wu AJ; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Jones DR; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
  • Molena D; Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Ann Surg ; 277(5): 781-788, 2023 05 01.
Article in En | MEDLINE | ID: mdl-36727949
OBJECTIVE: To assess postoperative morbidity, disease-free survival (DFS), and overall survival (OS) in patients treated with salvage esophagectomy (SE). BACKGROUND DATA: A shift toward a "surgery as needed" approach for esophageal cancer has emerged, potentially resulting in delayed esophagectomy. METHODS: We identified patients with clinical stage I-III esophageal adenocarcinoma or squamous cell carcinoma who underwent chemoradiation followed by esophagectomy from 2001 to 2019. SE was defined as esophagectomy performed >90 days after chemoradiation ("for time") and esophagectomy performed for recurrence after curative-intent chemoradiation ("for recurrence"). The odds of postoperative serious complications were assessed by multivariable logistic regression. The relationship between SE and OS and DFS were quantified using Cox regression models. RESULTS: Of 1137 patients identified, 173 (15%) underwent SE. Of those, 61 (35%) underwent SE for recurrence, and 112 (65%) underwent SE for time. The odds of experiencing any serious complication [odds ratio, 2.10 (95% CI, 1.37-3.20); P =0.001] or serious pulmonary complication [odds ratio, 2.11 (95% CI, 1.31-3.42); P =0.002] were 2-fold higher for SE patients; SE patients had a 1.5-fold higher hazard of death [hazard ratio, 1.56 (95% CI, 1.25-1.94); P <0.0001] and postoperative recurrence [hazard ratio, 1.43 (95% CI, 1.16-1.77); P =0.001]. Five-year OS for nonsalvage esophagectomy was 45% [(95% CI, 41.6%-48.6%) versus 26.5% (95% CI, 20.2%-34.8%) for SE (log-rank P <0.001)]. Five-year OS for SE for time was 27.1% [(95% CI, 19.5%-37.5%) versus 25.2% (95% CI, 15.3%-41.5%) for SE for recurrence ( P =0.611)]. CONCLUSIONS: SE is associated with a higher risk of serious postoperative complications and shorter DFS and OS.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Esophageal Neoplasms / Carcinoma, Squamous Cell / Adenocarcinoma Type of study: Etiology_studies / Risk_factors_studies Limits: Humans Language: En Journal: Ann Surg Year: 2023 Document type: Article Country of publication: United States

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Esophageal Neoplasms / Carcinoma, Squamous Cell / Adenocarcinoma Type of study: Etiology_studies / Risk_factors_studies Limits: Humans Language: En Journal: Ann Surg Year: 2023 Document type: Article Country of publication: United States