Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Eur J Surg Oncol. 2019 Jun;45(6):931-940. doi: 10.1016/j.ejso.2018.11.002. Epub 2018 Nov 10.
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.
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.
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]).
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.
根治性放化疗（dCRT）或新辅助放化疗（nCRT）后局部复发或持续性食管癌（EC），如果最初未进行手术，可作为挽救性手术的潜在适应证。本研究旨在评估这些患者接受挽救性手术的安全性和有效性。
我们按照 PRISMA 指南，系统地检索了 PubMed/Medline 数据库。所有纳入的研究均为在初始 dCRT 或 nCRT 治疗后，出现持续性或局部复发 EC 的患者。生存分析采用倒数方差权重法。
在检索到的 278 篇研究中，28 篇符合纳入标准，共纳入 1076 例患者。与局部区域复发患者相比，孤立性持续性 EC 患者接受挽救性食管切除术的术后并发症发生率更高，包括呼吸系统并发症（36.6% vs 22.7%，差异比[DR]10.9，95%置信区间[CI] [3.1; 18.7]）和心血管系统并发症（10.4% vs 4.5%，DR 5.9，95%CI [1.5; 10.2]）。汇总估计的 30 天和 90 天死亡率分别为 2.6%[1.6; 3.6]和 8.0%[6.3; 9.8]。汇总估计的 3 年和 5 年总生存率（OS）分别为 39.0%（95%CI：[35.8; 42.2]）和 19.4%[95%CI：16.5; 22.4]。初始 CRT 后孤立性持续性或局部复发 EC 患者的 5 年 OS 相似（14.0% vs 19.7%，DR -5.7，95%CI [-13.7; 2.3]）。
对于局部复发或持续性食管癌患者，挽救性手术是一种潜在的根治性治疗方法，在最初未进行手术时，可在根治性或新辅助放化疗后安全进行。
