Comparison of Clinical Outcomes between Salvage Esophagectomy and Esophagectomy without Preoperative Therapy

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  • 通常の手術例と比較した根治的化学放射線療法後のサルベージ食道切除術の治療成績
  • ツウジョウ ノ シュジュツレイ ト ヒカク シタ コンジテキ カガク ホウシャセン リョウホウ ゴ ノ サルベージ ショクドウ セツジョジュツ ノ チリョウ セイセキ

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We compared the clinicopathological factors of cases in which salvage esophagectomy was performed after definitive chemoradiotherapy (dCRT) with those of cases in which esophagectomy was performed without preoperative therapy. In this study, we reviewed the surgical procedures, postoperative complications and survival statistics between 21 patients undergoing salvage esophagectomy (S group) and 187 patients undergoing esophagectomy (NS group) without preoperative therapy, from January 2003 to December 2009. The operative procedures of both groups were not significantly different. The duration of operation of the S group was significantly shorter than that of the NS group, but the amount of blood loss did not differ. The incidence of anastomotic leakage was found to be higher in the S group. No patients demonstrated tracheal necrosis or hospital mortality in the S group. Recurrent diseases were found in 11 cases. One- and 3-years survival rates were 80% and 63.2%,respectively. In the S group, the prognosis of cases with Stage IV or lymph node metastasis before CRT was significantly poorer than the other cases. The thoracoscopic approach in salvage esophagectomy was a safe and feasible option. However, the rate of anastomotic leakage was high, and a procedure conducive to preservation of the tracheal blood flow is needed in salvage esophagectomy. Long-term survival was expected in only selected patients, even among patients after curative salvage esophagectomy.

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