A meta-analysis on salvage surgery as a potentially curative procedure in patients with isolated local recurrent or persistent esophageal cancer after chemoradiotherapy |
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| Institution: | 1. Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands;2. Department of Epidemiology, University of Groningen, University Medical Center Groningen, the Netherlands;3. Department of Surgery, Ziekenhuis Groep Twente, Almelo, the Netherlands;4. Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands;5. Department of Surgery, University of Rotterdam, Erasmus Medical Centre, Rotterdam, the Netherlands;1. Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, Guangdong Province, China;2. Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Sun Yat-sen University, Guangzhou, 510060, Guangdong Province, China;1. Centre Léon Bérard, Department of Surgical Oncology, Lyon, F-69008, France;2. Department of Biostatistics, University of Liverpool, Liverpool, L69 3BX, UK;3. Department of Anatomical and Cellular Pathology, State Key Laboratory in Oncology in South China, Prince of Wales Hospital, The Chinese University of Hong Kong, China;4. Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Chinese University of Hong Kong, China;5. Institute of Digestive Disease, Partner State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, China;6. Department of Medical and Surgical Sciences - DIMEC, Alma Mater Studiorum University of Bologna, Morgagni - Pierantoni Hospital, Forlì, Italy;7. Liverpool Hepatobiliary Centre, Aintree University Hospital, Longmoor Lane, Liverpool, L9 7AL, UK;8. Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, L69 3BX, UK;1. Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China;2. Department of Hematology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450003, China;1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China;2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China;3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China |
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| Abstract: | BackgroundIsolated local recurrent or persistent esophageal cancer (EC) after curative intended definitive (dCRT) or neoadjuvant chemoradiotherapy (nCRT) with initially omitted surgery, is a potential indication for salvage surgery. We aimed to evaluate safety and efficacy of salvage surgery in these patients.Material and methodsA systematic literature search following PRISMA guidelines was performed using databases of PubMed/Medline. All included studies were performed in patients with persistent or recurrent EC after initial treatment with dCRT or nCRT, between 2007 and 2017. Survival analysis was performed with an inverse-variance weighting method.ResultsOf the 278 identified studies, 28 were eligible, including a total of 1076 patients. Postoperative complications after salvage esophagectomy were significantly more common among patients with isolated persistent than in those with locoregional recurrent EC, including respiratory (36.6% versus 22.7%; difference in proportion 10.9 with 95% confidence interval (CI) 3.1; 18.7]) and cardiovascular complications (10.4% versus 4.5%; difference in proportion 5.9 with 95% CI 1.5; 10.2]). The pooled estimated 30- and 90-day mortality was 2.6% 1.6; 3.6] and 8.0% 6.3; 9.8], respectively. The pooled estimated 3-year and 5-year overall survival (OS) were 39.0% (95% CI: 35.8; 42.2]) and 19.4% 95% CI:16.5; 22.4], respectively. Patients with isolated persistent or recurrent EC after initial CRT had similar 5-year OS (14.0% versus 19.7%, difference in proportion ?5.7, 95% CI -13.7; 2.3]).ConclusionsSalvage surgery is a potentially curative procedure in patients with locally recurrent or persistent esophageal cancer and can be performed safely after definitive or neoadjuvant chemoradiotherapy when surgery was initially omitted. |
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| Keywords: | Esophageal cancer Salvage esophagectomy Definitive chemoradiotherapy |
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