Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Ann Surg. 2023 May 1;277(5):781-788. doi: 10.1097/SLA.0000000000005798. Epub 2023 Jan 19.
To assess postoperative morbidity, disease-free survival (DFS), and overall survival (OS) in patients treated with salvage esophagectomy (SE).
A shift toward a "surgery as needed" approach for esophageal cancer has emerged, potentially resulting in delayed esophagectomy.
We identified patients with clinical stage I-III esophageal adenocarcinoma or squamous cell carcinoma who underwent chemoradiation followed by esophagectomy from 2001 to 2019. SE was defined as esophagectomy performed >90 days after chemoradiation ("for time") and esophagectomy performed for recurrence after curative-intent chemoradiation ("for recurrence"). The odds of postoperative serious complications were assessed by multivariable logistic regression. The relationship between SE and OS and DFS were quantified using Cox regression models.
Of 1137 patients identified, 173 (15%) underwent SE. Of those, 61 (35%) underwent SE for recurrence, and 112 (65%) underwent SE for time. The odds of experiencing any serious complication [odds ratio, 2.10 (95% CI, 1.37-3.20); P =0.001] or serious pulmonary complication [odds ratio, 2.11 (95% CI, 1.31-3.42); P =0.002] were 2-fold higher for SE patients; SE patients had a 1.5-fold higher hazard of death [hazard ratio, 1.56 (95% CI, 1.25-1.94); P <0.0001] and postoperative recurrence [hazard ratio, 1.43 (95% CI, 1.16-1.77); P =0.001]. Five-year OS for nonsalvage esophagectomy was 45% [(95% CI, 41.6%-48.6%) versus 26.5% (95% CI, 20.2%-34.8%) for SE (log-rank P <0.001)]. Five-year OS for SE for time was 27.1% [(95% CI, 19.5%-37.5%) versus 25.2% (95% CI, 15.3%-41.5%) for SE for recurrence ( P =0.611)].
SE is associated with a higher risk of serious postoperative complications and shorter DFS and OS.
评估接受挽救性食管切除术（SE）治疗的患者的术后发病率、无病生存率（DFS）和总生存率（OS）。
对于食管癌，一种“按需手术”的方法已经出现，这可能导致食管切除术的延迟。
我们从 2001 年至 2019 年期间，确定了接受放化疗后接受食管切除术的临床 I-III 期食管腺癌或鳞状细胞癌患者。SE 定义为放化疗后>90 天进行的食管切除术（“时间”）和为根治性放化疗后复发而进行的食管切除术（“复发”）。使用多变量逻辑回归评估术后严重并发症的发生几率。使用 Cox 回归模型量化 SE 与 OS 和 DFS 的关系。
在确定的 1137 名患者中，有 173 名（15%）接受了 SE。其中，61 名（35%）因复发而接受 SE，112 名（65%）因时间而接受 SE。经历任何严重并发症的几率[比值比，2.10（95%CI，1.37-3.20）；P=0.001]或严重肺部并发症的几率[比值比，2.11（95%CI，1.31-3.42）；P=0.002]均高出 2 倍；SE 患者的死亡风险[风险比，1.56（95%CI，1.25-1.94）；P<0.0001]和术后复发[风险比，1.43（95%CI，1.16-1.77）；P=0.001]的风险高出 1.5 倍。非挽救性食管切除术的 5 年 OS 为 45%[（95%CI，41.6%-48.6%）与 SE 的 26.5%（95%CI，20.2%-34.8%）（对数秩 P<0.001）]。SE 中时间的 5 年 OS 为 27.1%[（95%CI，19.5%-37.5%）与 SE 中复发的 25.2%（95%CI，15.3%-41.5%）（P=0.611）]。
SE 与术后严重并发症以及较短的 DFS 和 OS 风险增加相关。
