A meta-analysis on salvage surgery as a potentially curative procedure in patients with isolated local recurrent or persistent esophageal cancer after chemoradiotherapy

Z Faiz; W P M Dijksterhuis; J G M Burgerhof; C T Muijs; V E M Mul; B P L Wijnhoven; J K Smit; J T M Plukker

doi:10.1016/j.ejso.2018.11.002

A meta-analysis on salvage surgery as a potentially curative procedure in patients with isolated local recurrent or persistent esophageal cancer after chemoradiotherapy

Eur J Surg Oncol. 2019 Jun;45(6):931-940. doi: 10.1016/j.ejso.2018.11.002. Epub 2018 Nov 10.

Authors

Z Faiz¹, W P M Dijksterhuis², J G M Burgerhof³, C T Muijs⁴, V E M Mul⁴, B P L Wijnhoven⁵, J K Smit⁶, J T M Plukker⁷

Affiliations

¹ Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: z.faiz@umcg.nl.
² Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
³ Department of Epidemiology, University of Groningen, University Medical Center Groningen, 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.
⁶ Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Surgery, Ziekenhuis Groep Twente, Almelo, the Netherlands.
⁷ Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. Electronic address: j.t.m.plukker@umcg.nl.

PMID: 30447937
DOI: 10.1016/j.ejso.2018.11.002

Abstract

Background: Isolated 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 methods: A 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.

Results: Of 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]).

Conclusions: Salvage 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.

Keywords: Definitive chemoradiotherapy; Esophageal cancer; Salvage esophagectomy.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adenocarcinoma / surgery*
Chemoradiotherapy*
Esophageal Neoplasms / surgery*
Esophageal Squamous Cell Carcinoma / surgery*
Esophagectomy*
Humans
Neoplasm Recurrence, Local / surgery*
Neoplasm, Residual
Salvage Therapy*

Supplementary concepts

Adenocarcinoma Of Esophagus