Clinical Outcomes and Prognosis of Salvage Thoracoscopic Esophagectomy after Definitive Chemoradiotherapy

We examined the treatment outcomes and survival rate of patients treated with salvage thoracoscopic esophagectomy after definitive chemoradiotherapy (dCRT). Twenty-seven patients who were indicated for salvage thoracoscopic esophagectomy after dCRT in our department were enrolled through April 2014. Eight patients had tumor regrowth after a complete response, and 19 had residual tumors. Two patients needed conversion to conventional thoracotomy. The operation time was 340 minutes (thoracic procedure: 125 minutes), and the estimated blood loss was 330 mL (thoracic procedure: 100 mL). The mean number of dissected nodes was 18. None of the patients experienced serious perioperative complications, and R0 surgery was performed in 24 patients. Postoperative complications developed in 15 patients (56%), and anastomotic leakage occurred in 11. Pneumonia developed in 3 patients, but none of the patients had tracheal necrosis or hospital mortality. The 5-year survival rate of all the patients was 40.4%, and the patient who underwent R0 surgery had a significantly better outcome than a patient with R1 or R2. Thoracoscopic esophagectomy is a safe option for salvage treatment of patients in an institution that has physicians experienced and skilled in thoracoscopic esophagectomy. However, it is always necessary to prepare for conversion to conventional thoracotomy.