Minimally invasive salvage esophagectomy following definitive chemoradiotherapy for esophageal cancer

Salvage esophagectomy is the only remaining treatment option for the potentially curative treatment of residual or recurrent esophageal cancer in patients who underwent definitive chemoradiotherapy (dCRT). However, its postoperative morbidity and mortality have been reported to be high. Although the minimally invasive method has become the preferred approach for nonsalvage esophagectomy because of its reduced surgical trauma and magnified view, its feasibility and oncological results for salvage esophagectomy remain unknown. A retrospective investigation was conducted on 45 patients who had undergone minimally invasive salvage esophagectomy for residual tumors or recurrence after dCRT between 2010 and 2024. There were 38 subtotal esophagectomies and seven total pharyngo-laryngo-esophagectomies. The R0 resection rate was 89%. Severe postoperative morbidity (≥Clavien-Dindo grade III) and overall postoperative morbidity (≥grade II) rates were 11% and 64%, respectively. Anastomotic leakage was found in 10 patients (22%). The rate of anastomotic leakage after dCRT with 60 Gy or more accounted for 31% (9/29), whereas it was 6% (1/16) after dCRT with no more than 50.4 Gy (P = 0.071). There was no 30-day or 90-day mortality. The 3-year overall survival rate and 3-year relapse-free survival (RFS) rates were 74% and 56%, respectively. When compared by pathological nodal status, patients who had positive pathological node metastasis showed considerably poorer RFS (P = 0.003). The 3-year RFS of pathologically node-positive patients was 20% and 69% in node-negative patients. In this article, we will describe the essence of our techniques for safe minimally invasive salvage esophagectomy.