Salvage esophagectomy combined with partial aortic wall resection following thoracic endovascular aortic repair
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Definitive chemoradiotherapy is useful for locally advanced esophageal cancer. However, salvage esophagectomy is required when residual or recurrent tumor is evident after chemoradiotherapy. We performed salvage esophagectomy combined with partial aortic wall resection after thoracic endovascular aortic repair for aortic invasion, and we evaluated the results.
Four patients underwent esophagectomy combined with aortic wall resection after thoracic endovascular aortic repair because the lesion was diagnosed as stage T4b. We evaluated short-term outcomes, including duration of thoracic surgery, blood loss, duration of intubation, intensive care unit stay, and postoperative morbidity, as well as survival after salvage surgery.
Lesions were resected with no intraoperative procedural adverse events. Mean thoracic operation time was 444 min, and mean thoracic blood loss was 506 g. In all patients, complete resection of the lesion was possible with no intraoperative adverse events. All patients were extubated on postoperative day 0, and all were discharged from the intensive care unit on postoperative day 1. One patient experienced grade II wound pain (bilateral chest pain), and another patient experienced difficult sputum expectoration (grade IIIA). The mean follow-up time was 19.8 months, and two patients were alive with no disease recurrence at the time of this report. However, the remaining two patients had died secondary to lymph node metastasis.
Salvage esophagectomy combined with partial aortic wall resection after thoracic endovascular aortic repair provides acceptable short-term outcomes. Future studies are needed to evaluate long-term survival and patient selection criteria.
KeywordsEsophageal cancer Salvage esophagectomy Thoracic endovascular aortic repair Chemoradiotherapy
We thank Jane Charbonneau, DVM, and Emily Truckenbrod, DVM, from Edanz Group (http://www.edanzediting.com/ac) for editing drafts of this manuscript.
Compliance with ethical standards
Conflict of interest
Masanobu Nakajima, Hiroto Muroi, Maiko Kikuchi, Satoru Yamaguchi, Kinro Sasaki, Takashi Tsuchioka, Yusuke Takei, Ikuko Shibasaki, Hirotsugu Fukuda, and Hiroyuki Kato declare no conflicts of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Before the operations, we obtained a general consent form from the patients for the use of their clinical data for clinical studies and registrations.
- 9.Ferrero E, Viazzo A, Ferri M, Rocca R, Pecchio A, Piazza S, et al. Acute management of aortoesophageal fistula and tracheoesophageal fistula treated by thoracic endovascular aortic repair and esophageal endoprosthesis: a case misdiagnosed as esophageal cancer. Ann Vasc Surg. 2011;25:1142.e1–5.Google Scholar
- 11.Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumors. ed 7. Oxford: Wiley-Blackwell; 2010.Google Scholar
- 26.Cohen C, Tessier W, Gronnier C, Renaud F, Pasquer A, Théreaux J, et al. FREGAT (French Eso-Gastric Tumors working group)—FRENCH (Fédération de Recherche en Chirurgie)—AFC (Association Française de Chirurgie). Salvage surgery for esophageal cancer: how to improve outcomes? Ann Surg Oncol. 2018;25:1277–86.CrossRefGoogle Scholar