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

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.