INTRODUCTION: Definitive chemoradiotherapy for inoperable oesophageal cancer is associated with locoregional failure in up to 50%, and failure to respond in 25-28%1,2. Salvage oesophagectomy in this setting has long been associated with increased morbidity and mortality, but study numbers have been limited.
AIM: The aim of this systematic review was to identify if there was a difference in morbidity, mortality and survival in those undergoing Salvage oesophagectomy compared with patients undergoing neo-adjuvant treatment followed by surgery.
METHODS: Database searches for relevant articles excluding reviews and non-English articles was undertaken. Morbidity, Mortality and Survival data was extracted, pooled and analysed. Comparative neoadjuvant complication rates were taken from the analysed articles.
RESULTS: 18 articles met the inclusion criteria, totalling 498 patients that were assessed. 202 patients had Stage3 or 4 disease. Salvage oesophagectomy was associated with increased rates of anastomotic and respiratory complications but similar cardiac or wound complications. Median length of stay was 29.9d, with 30d Mortality was 5.1% with a 5 year survival of 30.0%. R0 resection was associated with a better survival compared with R1/R2.
CONCLUSION: Salvage oesophagectomy is associated with increased morbidity, but mortality and long term survival are similar to patients undergoing neo-adjuvant treatment. This has possible clinical implications on who is defined as resectable, and that Salvage surgery is a viable option for patients with oesophageal cancer recurrence or non-response, after definitive treatment.