357. Postoperative Outcomes of Salvage Esophagectomy After Definitive Chemoradiotherapy and Planned Esophagectomy After Neoadjuvant Chemoradiotherapy

Abstract

Salvage esophagectomy is indicated for esophageal cancer patients for recurrent/persistent disease after definitive CRT (dCRT). Salvage esophagectomy reportedly has higher postoperative complications and poor survival. This study aimed to compare the perioperative outcomes and survival of patients with dCRT followed by salvage esophagectomy (DCRE) and neoadjuvant chemoradiotherapy (nCRT) followed by planned esophagectomy (NCRE) in esophageal squamous cell carcinoma (ESCC). Patients were identified from a prospectively maintained database at single institution from 2018 to 2021. All locally advanced ESCC patients receiving neoadjuvant/definitive chemoradiotherapy and following esophagectomy were reviewed. A total of 41 DCRE (24 persistent-disease, 17 recurrence) and 261 NCRE patients were included. Propensity score matching (PSM) was used to compensate for differences in some baseline characteristics. No significant between-group differences were identified in in-hospital mortality, postoperative complications (Figure A), overall-survival and progression-free survival (all p > 0.05) (Figure B-C). The median CRT-to-surgery interval was 47d in NCRE group, 43d and 440d in DCRE group of persistent-disease and recurrence, respectively. DCRE group was observed with more advanced ypT stage (63% vs 38%, p = 0.001), poorer differentiation (32% vs 15%, p = 0.005) and more lymphovascular invasion (29% vs 11%, p = 0.001) compared with NCRE. Similar results were obtained after PSM. Analyses comparing DCRE (due to persistent-disease), DCRE (due to recurrence) and NCRE groups showed no differences in postoperative complications, in-hospital mortality and survival. Postoperative complications and prognosis were equivalent between DCRE and NCRE. DCRE has acceptable outcomes and is appropriate for selected patients.