Surgical strategies for treatment of clinical T4 esophageal cancer in Japan

Abstract

Definitive chemoradiation (dCRT) is the mainstay treatment for cStage IVa esophageal squamous cell carcinoma (ESCC) with good performance status (PS), according to standard practice guidelines. Salvage surgery may incur operation complications and risk of mortality. According to the esophageal cancer practice guidelines outlined by the Japan Esophageal Society, when a tumor is residual and recurrent, chemotherapy and palliative symptomatic treatment is continued. However, salvage operation has been selected as a therapeutic option for recurrent or residual tumors after dCRT. There is weak evidence for not recommending surgery for cStage IVa ESCC exhibiting residual disease following dCRT. It has been reported that during salvage surgery the only prognostic factor that is thought to be performed is complete resection (R0), but at the same time, salvage esophagectomy increases the incidence of postoperative complications and mortality. The phase II chemoselection study by Yokota T et al. in Japan showed that multidisciplinary treatment initiated by induction therapy, in which docetaxel is added to cisplatin and 5-fluorouracil, resulted in a good prognosis in the short term. In this review, we discuss the surgical strategy and future of unresectable clinical T4 (cT4) ESCC.

Pectoralis Major Muscle Flap Utilization in Salvage Esophagectomy Including Great Vessel Resection Reconstructed by Prosthetic Grafts

“…Salvage operations have been selected as a therapeutic option for recurrent or residual tumors after dCRT. These procedures are rarely performed in Western countries, and owing to the technical challenges of the operations and the risk of mortality, 2 there is only weak evidence regarding the safety and usefulness of salvage surgery in the Japanese guidelines. However, this intervention is currently the only treatment that improves patient survival after dCRT.…”

“…1 However, salvage surgery has been used as a therapeutic option for recurrent or residual tumors after dCRT. It has been reported that, during salvage surgery, the only prognostic factor appears to be correlated with complete resection (R0) 2 ; therefore, any infiltrated adjacent organs should be resected if possible.…”

The prognostic value of systemic immune-inflammation index in surgical esophageal cancer patients: An updated meta-analysis

“…In Asian countries, squamous cell carcinoma (SCC) accounts for the major pathological type of esophageal cancer. Despite the great development of neoadjuvant chemotherapies and adjuvant chemoradiotherapies, the prognosis of esophageal cancer patients remains poor and surgery is still the most important treatment (3)(4)(5). Although the tumor-nodemetastasis (TNM) staging system is valuable for the prediction of prognosis and formulation of treatment strategy, patients with the same tumor stage may also experience completely different disease progression.…”