[Salvage surgery in esophageal cancer treatment -- its review in this decade and promises for the next decade].

ABSTRACT

Since admirable therapeutic results from definitive chemoradiotherapy(CRT)have been reported, it has been a curative option for all clinical stages of esophageal squamous cell carcinoma(ESCC)that could preserve the esophagus. From 2001 to 2009, we treated 981 new patients with ESCC in our institute. The rate of patients who chose definitive CRT as curative modality remained at about 70% in stage I and 20% in stage II - III . The number of salvage surgeries have not increased dramatically. In this decade, we had 97 cases of salvage surgery with right thoracotomy. Pathologically, no residual(R0) resection was performed in 80(82%)cases. The earlier the clinical stage, the better the overall survival. Seven patients(7%) died of severe complications, including bronchial necrosis and airway fistula. To avoid lethal complications, we established a retrosternal gastric pull-up without prophylactic neck lymph node dissection as a standard procedure of salvage surgery in 2006. Compared to other therapeutic treatments before and after 2006, this procedure could reduce fatal complications. However, overall survival remained at the same level. Salvage surgery is a complement to definitive CRT. It is necessary, therefore, to consider definitive CRT and salvage surgery comprehensively so as to increase positive therapeutic results with this multimodal strategy in patients with ESCC.