Salvage lymphadenectomy versus salvage radiotherapy/chemoradiotherapy for recurrence in cervical lymph node after curative resection of esophageal squamous cell carcinoma.

Abstract

A consensus treatment strategy for patients with esophageal squamous cell carcinoma (ESCC) that recurs after definitive esophagectomy has not been established. This study compared outcomes in ESCC patients who underwent salvage lymphadenectomy and those who underwent salvage radiotherapy/chemoradiotherapy for recurrence in cervical lymph nodes. Clinical characteristics of 79 patients were analyzed. Overall survival was calculated from the day of salvage treatment to the time of death or last follow-up. Survival rates were estimated using the Kaplan-Meier method, and statistical analysis was performed using the log-rank test for equality of the survival curves. The χ (2) test was used to compare patient and tumor characteristics. Univariate analysis was performed using the log-rank test, and multivariate analysis was performed using the Cox proportional hazards model. Initial treatment against recurrence (salvage lymphadenectomy vs. salvage radiotherapy or chemoradiotherapy) was the only significant prognostic factor with a hazard ratio of 2.358 and 95 % confidence interval of 1.067-5.210. Survival curves were significantly different between patients receiving salvage surgery and those receiving salvage radiotherapy/chemoradiotherapy (p = 0.0269). Compared with salvage radiotherapy/radiochemotherapy, salvage cervical lymphadenectomy might be the main treatment for esophageal carcinoma patients who developed cervical lymph node recurrence after curative esophagectomy.