Skip to main content
Journal cover image

It's not always too late: a case for minimally invasive salvage esophagectomy.

Publication ,  Journal Article
Broderick, RC; Lee, AM; Blitzer, RR; Zhao, B; Lam, J; Cheverie, JN; Sandler, BJ; Jacobsen, GR; Onaitis, MW; Kelly, KJ; Bouvet, M; Horgan, S
Published in: Surg Endosc
August 2021

INTRODUCTION: Standard of care for locally advanced esophageal carcinoma is neoadjuvant chemoradiation (nCRT) and surgical resection 4-8 weeks after completion of nCRT. It is recommended that the CRT to surgery interval not exceed 90 days. Many patients do not undergo surgery within this timeframe due to patient/physician preference, complete clinical response, or poor performance status. Select patients are offered salvage esophagectomy (SE), defined in two ways: resection for recurrent/persistent disease after complete response to definitive CRT (dCRT) or esophagectomy performed > 90 days after completion of nCRT. Salvage esophagectomy reportedly has higher postoperative morbidity and poor survival outcomes. In this study, we assessed outcomes, overall, and disease-free survival of patients undergoing salvage esophagectomy by both definitions (recurrent/persistent disease after dCRT and/or > 90 days), compared to planned (resection after nCRT/within 90 days) esophagectomy (PE). MATERIALS AND METHODS: Retrospective review of a prospectively maintained database identified patients who underwent minimally invasive esophagectomy at a single institution from 2009 to 2019. Esophagectomy for benign disease and patients who did not receive nCRT were excluded. Outcomes included postoperative complications, length of stay (LOS), disease-free survival, and overall survival. RESULTS: 97 patients underwent minimally invasive esophageal resection for esophageal carcinoma. 89.7% of patients were male. Mean age was 64.9 years (range 36-85 years). 94.8% of patients had adenocarcinoma, with 16 transthoracic and 81 transhiatal approaches. On comparing planned esophagectomy (n = 87) to esophagectomy after dCRT failure (n = 10), no significant differences were identified in overall survival (p = 0.73), disease-free survival (p = 0.32), 30-day or major complication rate, anastomotic leak, or LOS. Similarly, when comparing esophagectomy < 90 days after CRT (n = 62) to > 90 days after CRT completion (n = 35), no significant differences were identified in overall survival (p = 0.39), disease-free survival (p = 0.71), 30-day or major complication rate, LOS, or anastomotic leak rate between groups. In this comparison, local recurrence was noted to be elevated with SE as compared to PE (64.3% vs. 25.0%, p = 0.04). CONCLUSION: Overall survival and disease-free survival were equivalent between SE and PE. Local recurrence was noted to be increased with SE, though this did not appear to affect survival. Although planned esophagectomy remains the standard of care, salvage esophagectomy has comparable outcomes and is appropriate for selected patients.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Surg Endosc

DOI

EISSN

1432-2218

Publication Date

August 2021

Volume

35

Issue

8

Start / End Page

4700 / 4711

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Salvage Therapy
  • Retrospective Studies
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Humans
  • Esophagectomy
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Broderick, R. C., Lee, A. M., Blitzer, R. R., Zhao, B., Lam, J., Cheverie, J. N., … Horgan, S. (2021). It's not always too late: a case for minimally invasive salvage esophagectomy. Surg Endosc, 35(8), 4700–4711. https://doi.org/10.1007/s00464-020-07937-2
Broderick, Ryan C., Arielle M. Lee, Rachel R. Blitzer, Beiqun Zhao, Jenny Lam, Joslin N. Cheverie, Bryan J. Sandler, et al. “It's not always too late: a case for minimally invasive salvage esophagectomy.Surg Endosc 35, no. 8 (August 2021): 4700–4711. https://doi.org/10.1007/s00464-020-07937-2.
Broderick RC, Lee AM, Blitzer RR, Zhao B, Lam J, Cheverie JN, et al. It's not always too late: a case for minimally invasive salvage esophagectomy. Surg Endosc. 2021 Aug;35(8):4700–11.
Broderick, Ryan C., et al. “It's not always too late: a case for minimally invasive salvage esophagectomy.Surg Endosc, vol. 35, no. 8, Aug. 2021, pp. 4700–11. Pubmed, doi:10.1007/s00464-020-07937-2.
Broderick RC, Lee AM, Blitzer RR, Zhao B, Lam J, Cheverie JN, Sandler BJ, Jacobsen GR, Onaitis MW, Kelly KJ, Bouvet M, Horgan S. It's not always too late: a case for minimally invasive salvage esophagectomy. Surg Endosc. 2021 Aug;35(8):4700–4711.
Journal cover image

Published In

Surg Endosc

DOI

EISSN

1432-2218

Publication Date

August 2021

Volume

35

Issue

8

Start / End Page

4700 / 4711

Location

Germany

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Salvage Therapy
  • Retrospective Studies
  • Neoplasm Recurrence, Local
  • Neoadjuvant Therapy
  • Middle Aged
  • Male
  • Humans
  • Esophagectomy