Salvage Surgery for Esophageal Cancer: How to Improve Outcomes?
- 113 Downloads
Locoregional recurrence rates after definitive chemoradiotherapy (dCRT) for locally advanced esophageal cancer (EC) are high. Salvage surgery (SALV) is considered the best treatment option in case of persistent or recurrent disease for operable patients, but SALV has been associated with increased morbidity and mortality. The aim of this study is to identify factors linked to outcomes after SALV to better select candidates and to optimize perioperative care.
We retrospectively analyzed data from 308 consecutive SALV patients from a large multicenter European cohort. Univariate and multivariate analyses were performed to identify factors associated with in-hospital postoperative morbidity, anastomotic leakage (AL), and overall survival (OS).
The in-hospital postoperative mortality and morbidity rates were 8.4 and 34.7%, respectively. Squamous cell histology (p = 0.040) and radiation dose ≥ 55 Gy (p = 0.047) were independently associated with major morbidity. The AL rate was 12.7%, and cervical anastomosis was independently associated with AL (p = 0.002). OS at 5 years was 34.0%. Radiation dose ≥ 55 Gy (p = 0.003), occurrence of postoperative complications (p = 0.006), ypTNM stage 3 (p = 0.019), and positive surgical margins (p < 0.001) were linked to poor prognosis.
SALV is a valuable option for patients with persistent or recurrent disease after dCRT and offers long-term survival. Factors such as radiation dose and anastomosis location identified here will help to optimize outcomes after SALV, which may be considered a standard treatment in the EC therapeutic armamentarium.
Collaborators for the FREGAT (French Eso-Gastric Tumors working group) – FRENCH (Fédération de Recherche en Chirurgie) – AFC (Association Française de Chirurgie) Working Groups
Abdennahceur Dhahri, MD, PhD, Delphine Lignier, MD, Cyril Cossé, MD, Jean-Marc Regimbeau, MD, PhD, Department of Digestive Surgery, Amiens, France; Guillaume Luc, MD, Department of Digestive Surgery, Bordeaux, France; Magalie Cabau, MD, Jacques Jougon MD, PhD, Department of Thoracic Surgery, Bordeaux, France; Bogdan Badic, MD, Patrick Lozach, MD, Jean Pierre Bail, MD, Department of Digestive Surgery, Brest, France; Serge Cappeliez, MD, PhD, Issam El Nakadi, MD, PhD, Department of Digestive Surgery, Brussel ULB, Erasme Bordet University, Brussel, Belgium; Gil Lebreton, MD, Arnaud Alves, MD, PhD, Department of Digestive Surgery, Caen, France; Renaud Flamein, MD, Denis Pezet, MD, PhD, Department of Digestive Surgery, Clermont-Ferrand, France; Federica Pipitone, MD, Bogdan Stan-Iuga, MD, Nicolas Contival, MD, Eric Pappalardo, MD, Xaviera Coueffe, MD, Simon Msika, MD, PhD, Department of Digestive Surgery, Louis Mourier University Hospital, Colombes, France; Styliani Mantziari, MD, Nicolas Demartines, MD, Department of Digestive Surgery, Lausanne University Hospital, Lausanne, Switzerland; Flora Hec, MD, Marguerite Vanderbeken, MD, Nicolas Briez, MD, Department of Digestive Surgery, Lille, France; Fabien Fredon, MD, Alain Gainant, MD, Muriel Mathonnet, MD, PhD, Department of Digestive Surgery, Limoges, France; Jean Marc Bigourdan, MD, Salim Mezoughi, MD, Christian Ducerf, MD, Jacques Baulieux, MD, Jean-Yves Mabrut, MD, PhD, Department of Digestive Surgery, Croix Rousse University Hospital, Lyon, France; Oussama Baraket, MD, Gilles Poncet, MD, Mustapha Adam, MD, PhD, Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France; Delphine Vaudoyer, MD, Peggy Jourdan Enfer, MD, Laurent Villeneuve, MD, Olivier Glehen, MD, PhD, Department of Digestive Surgery, Lyon Sud University Hospital, Lyon, France; Thibault Coste, MD, Jean-Michel Fabre, MD, Department of Digestive Surgery, Montpellier, France; Frédéric Marchal, MD, Department of Digestive Surgery, Institut de cancérologie de Lorraine, Nancy, France; Romain Frisoni, MD, Ahmet Ayav, MD, PhD, Laurent Brunaud, MD, PhD, Laurent Bresler, MD, Department of Digestive Surgery, Nancy, France; Olivier Aze, MD, Nicolas Venissac, MD, Daniel Pop, MD, Jérôme Mouroux, MD, Department of Thoracic Surgery, Nice, France; Ion Donici, MD, Michel Prudhomme, MD, PhD, Department of Digestive Surgery, Nîmes, France; Emanuele Felli, MD, Stéphanie Lisunfui, MD, Marie Seman, MD, Gaelle Godiris Petit, MD, Mehdi Karoui, MD, PhD, Christophe Tresallet, MD, PhD, Fabrice Ménégaux, MD, PhD, Jean-Christophe Vaillant, MD, Laurent Hannoun, MD, Department of Digestive Surgery, Pitié-Salpétrière University Hospital, Paris, France; Brice Malgras, MD, Denis Lantuas, MD, Karine Pautrat, MD, Marc Pocard, MD, PhD, Patrice Valleur, MD, Department of Digestive Surgery, Lariboisière University Hospital, Paris, France; Jérémie H Lefevre, MD, PhD, Najim Chafai, MD, Pierre Balladur, MD, Magalie Lefrançois, MD, Yann Parc, MD, PhD, François Paye, MD, PhD Emmanuel Tiret, MD Department of Digestive Surgery, Saint-Antoine University Hospital, Paris, France; Marius Nedelcu, MD, Letizia Laface, MD, Thierry Perniceni, MD, Brice Gayet, MD, Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France; Kathleen Turner, MD, Department of Digestive Surgery, Rennes, France; Alexandre Filipello, MD, Jack Porcheron, MD, Olivier Tiffet, MD, PhD, Department of Digestive Surgery, Saint-Etienne, France; Noémie Kamlet, MD, Rodrigue Chemaly, MD, Amandine Klipfel, MD, Patrick Pessaux, MD, PhD, Cecile Brigand, MD, PhD, Serge Rohr MD, Department of Digestive Surgery, Strasbourg, France; Nicolas Carrère, MD, PhD, Department of Digestive Surgery, Toulouse, France; Chiara Da Re, MD, Frédéric Dumont, MD, Diane Goéré, MD, PhD, Dominique Elias, MD, Department of Digestive Surgery Institut Gustave-Roussy, Villejuif, France; Claude Bertrand, MD, Mont-Godinne University Hospital, Yvoir, Belgium.
Study conception and design: Williams TESSIER and Christophe MARIETTE; Acquisition of data: All authors; Analysis and interpretation of data: Charlotte COHEN, Williams TESSIER, Caroline GRONNIER, Guillaume PIESSEN, and Christophe MARIETTE; Drafting of manuscript: Charlotte COHEN, Williams TESSIER, and Christophe MARIETTE; Critical revision: All authors.
- 5.Stahl M, Mariette C, Haustermans K, et al. Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi52–56.Google Scholar
- 6.Thésaurus National de Cancerologie Digestive. Société nationale française de gastroenterologie. Chapitre 1: Cancer de l’oesophage. http://www.tncd.org. Accessed 21 Aug 21 2015.
- 11.Mariette C, Piessen G, Briez N, Triboulet JP. The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg. 2008;247:365–71.CrossRefPubMedGoogle Scholar
- 14.Edge SB, Byrd DR, Compton CC, eds. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010:103–115.Google Scholar
- 41.NCCN esophageal cancer guidelines. http://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf. Accessed 20 Aug 2015.
- 44.Vincent J, Mariette C, Pezet D, et al. Early surgery for failure after chemoradiation in operable thoracic oesophageal cancer. Analysis of the non-randomised patients in FFCD 9102 phase III trial: Chemoradiation followed by surgery versus chemoradiation alone. Eur J Cancer. 2015;51:1683–93.CrossRefPubMedGoogle Scholar