P1.178. Perioperative, Survival, and Oncologic Outcomes After Salvage Versus Planned Esophagectomy

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer Salvage esophagectomy represents an alternative strategy to standard multimodal treatment of resectable esophageal cancer. However, its definition is heterogeneous and further investigation is required to better characterize outcomes and inform patient selection. Esophagectomies performed between January 2010 and 2023 were retrospectively analysed. Patients were stratified into planned esophagectomy (PE) and salvage esophagectomy (SE) groups. SE was defined as surgery performed for: 1. Residual disease after definitive chemoradiotherapy (dCRT), 2. Recurrence post-dCRT, 3. dCRT downstaging T4b to resectable, 4. Oligometastatic disease, 5. Recurrent disease after previous resection, or 6. Delayed time interval post-neoadjuvant CRT. Outcomes measured included perioperative variables and complications, and overall- (OS) and disease-free survival (DFS). Among 492 patients, 66 (14.6%) underwent SE. Compared to the PE group, SE patients were younger, more frequently male, had a higher proportion of squamous cell carcinoma, and had less N3 disease. SE was associated with longer median hospital stays (12.5 vs. 10 days, p=0.009), higher rates of anastomotic leaks (21.2% vs. 4.1%, p<0.001), respiratory complications (27.3% vs. 7.5%, p<0.001), major complications (31.8% vs. 10.9%, p<0.001), and in-hospital mortality (10.6% vs. 1.3%, p<0.001). Despite increased perioperative morbidity, there were no significant differences in OS or DFS on log-rank analysis. On multivariable analysis, SE was not independently associated with worse OS or DFS. SE was associated with higher perioperative morbidity and mortality than PE, but did not compromise long-term OS or DFS. Favourable survival outcomes were observed in patients with residual disease post-dCRT and in selected cases of stable oligometastatic disease. Indication-specific risk stratification and considered multidisciplinary patient selection are crucial when considering salvage esophagectomy.