Salvage resections for recurrent or persistent cancer of the proximal esophagus after chemoradiotherapy

Colin Schieman, Dennis A Wigle, Claude Deschamps, Francis C. Nichols, Stephen D. Cassivi, K. Robert Shen, Mark S. Allen

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Cancer of the cervical esophagus is uncommon and typically presents with locally advanced disease. Management is challenging and generally involves definitive chemoradiotherapy. A segment of patients will experience locoregional failure after chemoradiotherapy with either persistent or recurrent cancer. The benefit of so-called salvage surgical resection in this group of patients remains unclear and is the focus of this article. Methods: We conducted a retrospective review of all patients who underwent resection for recurrent or persistent squamous cell carcinoma of the proximal esophagus after chemoradiotherapy at the Mayo Clinic, Rochester, Minnesota, between January 1, 1990 and December 31, 2005. Results: Twelve patients were studied: 5 (42%) with recurrent cancer and 7 (58%) with persistent cancer. The median age of the patients was 59 years (range, 42-73 years), and 8 patients were men (67%). Eight patients (67%) underwent pharyngolaryngectomy and 4 patients (33%) underwent McKeown's esophagectomy. Two patients (17%) had positive margins at the time of resection. Five patients (42%) experienced 1 or more perioperative complications. Median length of hospitalization was 15 days (range, 9-29 days) and median follow-up was 22 months (range, 1-159 months). Overall 1, 3, 5, and 10-year survival rates were 75%, 33%, 17%, and 8%, respectively. Median survival was 21 months. Cause of death was recurrent cancer in 10 patients (83%) and perioperative death in 1 patient (8%). Conclusions: The opportunity for long-term survival after salvage resection for persistent or recurrent cancer of the proximal esophagus exists but is limited and must be thoughtfully balanced with the perioperative morbidity of such challenging resections by both patients and physicians.

Original languageEnglish (US)
Pages (from-to)459-463
Number of pages5
JournalAnnals of Thoracic Surgery
Volume95
Issue number2
DOIs
StatePublished - Feb 2013

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Chemoradiotherapy
Esophageal Neoplasms
Neoplasms
Esophagectomy
Survival
Esophagus
Cause of Death
Squamous Cell Carcinoma
Hospitalization
Survival Rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Salvage resections for recurrent or persistent cancer of the proximal esophagus after chemoradiotherapy. / Schieman, Colin; Wigle, Dennis A; Deschamps, Claude; Nichols, Francis C.; Cassivi, Stephen D.; Shen, K. Robert; Allen, Mark S.

In: Annals of Thoracic Surgery, Vol. 95, No. 2, 02.2013, p. 459-463.

Research output: Contribution to journalArticle

Schieman, Colin ; Wigle, Dennis A ; Deschamps, Claude ; Nichols, Francis C. ; Cassivi, Stephen D. ; Shen, K. Robert ; Allen, Mark S. / Salvage resections for recurrent or persistent cancer of the proximal esophagus after chemoradiotherapy. In: Annals of Thoracic Surgery. 2013 ; Vol. 95, No. 2. pp. 459-463.
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abstract = "Background: Cancer of the cervical esophagus is uncommon and typically presents with locally advanced disease. Management is challenging and generally involves definitive chemoradiotherapy. A segment of patients will experience locoregional failure after chemoradiotherapy with either persistent or recurrent cancer. The benefit of so-called salvage surgical resection in this group of patients remains unclear and is the focus of this article. Methods: We conducted a retrospective review of all patients who underwent resection for recurrent or persistent squamous cell carcinoma of the proximal esophagus after chemoradiotherapy at the Mayo Clinic, Rochester, Minnesota, between January 1, 1990 and December 31, 2005. Results: Twelve patients were studied: 5 (42{\%}) with recurrent cancer and 7 (58{\%}) with persistent cancer. The median age of the patients was 59 years (range, 42-73 years), and 8 patients were men (67{\%}). Eight patients (67{\%}) underwent pharyngolaryngectomy and 4 patients (33{\%}) underwent McKeown's esophagectomy. Two patients (17{\%}) had positive margins at the time of resection. Five patients (42{\%}) experienced 1 or more perioperative complications. Median length of hospitalization was 15 days (range, 9-29 days) and median follow-up was 22 months (range, 1-159 months). Overall 1, 3, 5, and 10-year survival rates were 75{\%}, 33{\%}, 17{\%}, and 8{\%}, respectively. Median survival was 21 months. Cause of death was recurrent cancer in 10 patients (83{\%}) and perioperative death in 1 patient (8{\%}). Conclusions: The opportunity for long-term survival after salvage resection for persistent or recurrent cancer of the proximal esophagus exists but is limited and must be thoughtfully balanced with the perioperative morbidity of such challenging resections by both patients and physicians.",
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AU - Shen, K. Robert

AU - Allen, Mark S.

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N2 - Background: Cancer of the cervical esophagus is uncommon and typically presents with locally advanced disease. Management is challenging and generally involves definitive chemoradiotherapy. A segment of patients will experience locoregional failure after chemoradiotherapy with either persistent or recurrent cancer. The benefit of so-called salvage surgical resection in this group of patients remains unclear and is the focus of this article. Methods: We conducted a retrospective review of all patients who underwent resection for recurrent or persistent squamous cell carcinoma of the proximal esophagus after chemoradiotherapy at the Mayo Clinic, Rochester, Minnesota, between January 1, 1990 and December 31, 2005. Results: Twelve patients were studied: 5 (42%) with recurrent cancer and 7 (58%) with persistent cancer. The median age of the patients was 59 years (range, 42-73 years), and 8 patients were men (67%). Eight patients (67%) underwent pharyngolaryngectomy and 4 patients (33%) underwent McKeown's esophagectomy. Two patients (17%) had positive margins at the time of resection. Five patients (42%) experienced 1 or more perioperative complications. Median length of hospitalization was 15 days (range, 9-29 days) and median follow-up was 22 months (range, 1-159 months). Overall 1, 3, 5, and 10-year survival rates were 75%, 33%, 17%, and 8%, respectively. Median survival was 21 months. Cause of death was recurrent cancer in 10 patients (83%) and perioperative death in 1 patient (8%). Conclusions: The opportunity for long-term survival after salvage resection for persistent or recurrent cancer of the proximal esophagus exists but is limited and must be thoughtfully balanced with the perioperative morbidity of such challenging resections by both patients and physicians.

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