Survival Outcomes of Esophageal Squamous Cell Carcinoma Patients Who Underwent Salvage Esophagectomy: A Literature Review and Results From Two High-Volume Centers

Abstract

Background

This study aimed to investigate survival outcomes, the efficacy of lymph node (LN) dissection, and recurrence patterns in patients who underwent salvage surgery (SALV) for esophageal squamous cell carcinoma (ESCC) after definitive chemoradiotherapy (dCRT).

Methods

We retrospectively reviewed 69 patients with clinical stage I–IV thoracic ESCC who underwent SALV. Recurrence patterns and the distribution of LN metastases were analyzed according to the primary tumor location.

Results

The 90-day mortality rate was 2.9%, and the 3-year overall survival (OS) rate of the 69 patients was 47.1%. OS curves were significantly stratified by the presence of abdominal LN metastases (p = 0.007). Among six patients whose clinically positive LNs were not dissected because their swelling disappeared after dCRT (cN+/CRT-cN0 cases), two (33.3%) developed locoregional recurrence. In contrast, among 25 patients whose clinically positive LNs were dissected regardless of CRT-cN status, the incidence of locoregional recurrence alone was 4.0%. Patients with lower thoracic (Lt) tumors had a higher incidence of distant metastases than those with middle (Mt) or upper thoracic (Ut) tumors (61.5% vs. 36.8%/33.3%). Mediastinal LN metastases were rare (7.7%) in Lt tumors, whereas LN metastases were widely distributed within the regional zones in Mt/Ut tumors. Patients with Lt tumors and pathological LN metastases had extremely poor OS (3-year OS: 0%).

Conclusions

Abdominal LN metastases had a negative impact on survival in ESCC patients who underwent SALV. Clinically positive LNs should be dissected, provided it is technically feasible. The tumor location might influence the distribution and prognostic impact of pathological LN metastases.