Salvage Esophagectomy: Why it Makes Sense to Selectively Resect Squamous Cell Carcinoma

Previous clinical trials have concluded that trimodality and bimodality therapy are equivalent for treating locally advanced esophageal squamous cell carcinoma (ESCC). However, the use of chemoradiation alone achieves only a 45% to 50% complete response rate. Surgery remains crucial for locoregional control. In ESCC, salvage esophagectomy for locoregional recurrence has increased morbidity compared to planned esophagectomy. Retrospective data suggest that patients requiring cervical/upper chest anastomosis are more likely to undergo salvage esophagectomy rather than completing trimodality therapy. It’s unclear if selective surgery versus an operative approach on all patients after chemoradiation leads to differences in overall outcomes.