Salvage endoscopic resection after definitive chemoradiotherapy for esophageal cancer: a Western experience.

Background and Aims Definitive chemoradiotherapy (CRT) is increasingly used as a nonsurgical treatment for esophageal cancer. In Japanese studies, salvage endoscopic resection (ER) has emerged as a promising strategy for local failure after definitive CRT. We aimed to evaluate the safety and efficacy of salvage ER in a Western setting. Methods Gastroenterologists from Europe and the United States were invited to submit their experience with salvage endoscopic submucosal dissection (ESD) or endoscopic mucosal resection (EMR) after definitive CRT. Participating gastroenterologists completed an anonymized database, including patient demographics, clinicopathological variables, and follow-up on survival and recurrence. Results Gastroenterologists from 10 endoscopic units in 6 European countries submitted information on 25 patients. A total of 35 salvage ER procedures were performed, of which 69% were ESD and 31% EMR. The majority of patients had squamous cell carcinoma (64%) of the middle or lower esophagus (68%), staged as cT2-3 (68%) and cN+ (52%) before definitive CRT. Median time from end of definitive CRT to ER was 22 months (IQR 6-47). The en-bloc resection rate was 92% for ESD and 46% for EMR. During a median of 24 months (IQR 12-59) follow-up after salvage ER, 52% developed a recurrence (11 locoregional, 2 distant). The 5-year recurrence-free survival, overall survival, and disease-specific survival were 36%, 52%, and 79%, respectively. No major intra- or postprocedural adverse events, such as bleeding or perforation, were reported. Conclusions In carefully selected esophageal cancer patients, salvage ER is technically feasible after definitive CRT. Further prospective research is recommended to validate the safety and effectivity of salvage ER for the management of local failure.