Introduction: The standard treatment for unresectable cT4 thoracic esophageal cancer with invasion to other organs has not been established. In addition, the long-term prognosis of conversion surgery after strong pretreatment is not clear. Definitive
chemoradiotherapy (dCRT) can preserve the esophagus in successful cases, and
salvage surgery can be considered as a salvage treatment if residual or
recurrent cases can be resected. Therefore, our hospital actively selects dCRT as the initial treatment as the treatment of conversion surgery for unresectable esophageal cancer.
Purpose: Our purpose is to clarify the long-term prognosis of salvage surgery after dCRT for locally advanced esophageal cancer.
Material and Meyhods: Of the patients who underwent salvage surgery for thoracic esophageal cancer in our hospital from February 2012 to December 2017, we examined 21 patients who were diagnosed with cT4 thoracic esophageal cancer without distant metastases at the first visit. Male / female: 14/7, median age 67 years (38-79 years). Invasive / suspicious organs were aorta in 7 cases, trachea / left main tracheal branch in 10 cases, and other 4 cases. 18 cases of remnant lesion after dCRT and local relapse 3 cases after complete remission were examined retrospectively for the long-term results.
Results: The median observation period was 28.9 months, and recurrence was observed in 12 cases (57.1%). The median postoperative recurrence-free survival of 12 patients with postoperative recurrence was 7.3 months (2.0-48.0 months), and 10 patients had recurrence within 1 year after surgery. The 1-year survival rate was 80.1% and the 2-year survival rate was 57.1% after initial treatment.
Coclusion: The long-term results of salvage surgery after dCRT for unresectable thoracic esophageal cancer are considered acceptable even in consideration of a small number of cases, and may be one of the treatment options for Coversion for unresectable esophageal cancer.