Chinese expert consensus on salvage esophagectomy for esophageal cancer after definitive chemoradiotherapy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIN Zhaoxian ¹ , HU Yang ² , XIAN Lei ³ , LI Yun ⁴ , ZHAO Jinbo ⁵ , HOU Xiaobin ⁶ , ZHANG Shuangping ⁷ , KE Sunkui ⁸ , GUO Changying ⁹ ,  XIE Songping ¹⁰ ,  WEI Haitao ¹¹ ,  LI Yong ¹² , Integrated Esophageal Cancer Committee of Chinese Anti-Cancer Association

1. Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou University, Fuzhou, 350001, P. R. China;
2. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Department of Thoracic Surgery, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530005, P. R. China;
4. Department of Thoracic Surgery, Shandong Provincial Hospital, Jinan, 250022, P. R. China;
5. Department of Thoracic Surgery, Tangdu Hospital, Air Force Medical University, Xi'an, 710038, P. R. China;
6. Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing, 100853, P. R. China;
7. Department of Thoracic Surgery, Shanxi Province Cancer Hospital, Taiyuan, 030000, P. R. China;
8. Department of Thoracic Surgery, Zhongshan Hospital Xiamen University, Xiamen, 361000, Fujian, P. R. China;
9. Department of Thoracic Surgery, Jiangxi Cancer Hospital, Nanchang, 330029, P. R. China;
10. Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, P. R. China;
11. Department of Thoracic Surgery, Huaihe Hospital of Henan University, Kaifeng, 475099, Henan, P. R. China;
12. Department of Thoracic Surgery, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, P. R. China;

Corresponding?author：

XIE Songping, Email: songping0428@126.com; WEI Haitao, Email: taoge9885@163.com; LI Yong, Email: liyongdoctor@126.com

Keywords：

Salvage esophagectomy; definitive chemoradiotherapy; esophageal cancer; esophageal squamous cell carcinoma; retrosternal reconstruction; expert consensus

DOI：

10.7507/1007-4848.202605072

Video：

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Abstract Full text Figures/Tables Video References Cited by

Definitive chemoradiotherapy (dCRT) has become a cornerstone in the treatment of locally advanced esophageal cancer; however, local control remains suboptimal, and persistent lesions or locoregional recurrences after treatment are not uncommon. For patients without distant metastases but with local failure, whether surgical intervention can still offer curative potential remains a major clinical dilemma. Salvage esophagectomy (SE) offers potential long-term survival for selected patients, but this procedure is performed in the context of severe fibrosis, impaired local blood supply, and obscured anatomical planes following chemoradiotherapy, resulting in significantly higher perioperative risk compared to primary esophagectomy. Consequently, controversies exist regarding patient selection, preoperative restaging, choice of surgical approach, extent of lymphadenectomy, gastrointestinal reconstruction, and perioperative management. In recent years, with the refinement of restaging modalities such as PET/CT, the accumulation of experience in high-volume centers, and emerging evidence from clinical studies, the clinical role of SE has gradually shifted from a "high-risk salvage measure" to a "selective curative strategy aimed at achieving long-term survival in carefully selected patients". Nevertheless, standardized guidelines for patient selection, technical approaches, and perioperative management are still lacking. Based on current evidence and clinical experience, experts organized by the Integrated Esophageal Cancer Committee of Chinese Anti-Cancer Association systematically reviewed key issues regarding SE, including its definition, indications, preoperative evaluation, choice of surgical approach, lymphadenectomy, gastrointestinal reconstruction, and perioperative management, and formulated a Chinese expert consensus. This consensus aims to provide guidance for standardized assessment, appropriate referral, individualized surgical decision-making, and optimized perioperative management of patients with locoregional failure after dCRT. Ultimately, this will increase the likelihood of R0 resection, reduce the risk of severe complications, and promote the safer, more judicious, and standardized implementation of SE in high-risk scenarios.

Citation： LIN Zhaoxian, HU Yang, XIAN Lei, LI Yun, ZHAO Jinbo, HOU Xiaobin, ZHANG Shuangping, KE Sunkui, GUO Changying, XIE Songping, WEI Haitao, LI Yong, Integrated Esophageal Cancer Committee of Chinese Anti-Cancer Association. Chinese expert consensus on salvage esophagectomy for esophageal cancer after definitive chemoradiotherapy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(7): 977-987. doi: 10.7507/1007-4848.202605072 Copy

1.	Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). JAMA, 1999, 281(17): 1623-1627.
2.	Swisher SG, Wynn P, Putnam JB, et al. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg, 2002, 123(1): 175-183.
3.	Katano A, Yamashita H, Nakagawa K. Re-irradiation of locoregional esophageal cancer recurrence following definitive chemoradiotherapy: a report of 6 cases. Mol Clin Oncol, 2017, 7(4): 681-686.
4.	Jamel S, Markar SR. Salvage esophagectomy: safe therapeutic strategy? J Thorac Dis, 2017, 9(Suppl 8): S799-S808.
5.	Nishimura Y, Suzuki M, Nakamatsu K, et al. Prospective trial of concurrent chemoradiotherapy with protracted infusion of 5-fluorouracil and cisplatin for T4 esophageal cancer with or without fistula. Int J Radiat Oncol Biol Phys, 2002, 53(1): 134-139.
6.	Ishida K, Ando N, Yamamoto S, et al. Phase Ⅱ study of cisplatin and 5-fluorouracil with concurrent radiotherapy in advanced squamous cell carcinoma of the esophagus: a Japan Esophageal Oncology Group (JEOG)/Japan Clinical Oncology Group trial (JCOG9516). Jpn J Clin Oncol, 2004, 34(10): 615-619.
7.	Tomblyn MB, Goldman BH, Thomas CR, et al. Cetuximab plus cisplatin, irinotecan, and thoracic radiotherapy as definitive treatment for locally advanced, unresectable esophageal cancer: a phase-Ⅱ study of the SWOG (S0414). J Thorac Oncol, 2012, 7(5): 906-912.
8.	Higuchi K, Komori S, Tanabe S, et al. Definitive chemoradiation therapy with docetaxel, cisplatin, and 5-fluorouracil (DCF-R) in advanced esophageal cancer: a phase 2 trial (KDOG 0501-P2). Int J Radiat Oncol Biol Phys, 2014, 89(4): 872-879.
9.	Satake H, Tahara M, Mochizuki S, et al. A prospective, multicenter phase Ⅰ/Ⅱ study of induction chemotherapy with docetaxel, cisplatin and fluorouracil (DCF) followed by chemoradiotherapy in patients with unresectable locally advanced esophageal carcinoma. Cancer Chemother Pharmacol, 2016, 78(1): 91-99.
10.	Hihara J, Hamai Y, Emi M, et al. Role of definitive chemoradiotherapy using docetaxel and 5-fluorouracil in patients with unresectable locally advanced esophageal squamous cell carcinoma: a phase Ⅱ study. Dis Esophagus, 2016, 29(8): 1115-1120.
11.	Park S, Oh D, Choi YL, et al. Durvalumab and tremelimumab with definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma. Cancer, 2022, 128(11): 2148-2158.
12.	Yi Q, Liu C, Cui Y, et al. Chemoradiotherapy with paclitaxel liposome plus cisplatin for locally advanced esophageal squamous cell carcinoma: a retrospective analysis. Cancer Med, 2023, 12(6): 6477-6487.
13.	Meunier B, Raoul J, Le Prisé E, et al. Salvage esophagectomy after unsuccessful curative chemoradiotherapy for squamous cell cancer of the esophagus. Dig Surg, 1998, 15(3): 224-226.
14.	Kitagawa Y, Ishihara R, Ishikawa H, et al. Esophageal cancer practice guidelines 2022 edited by the Japan Esophageal Society: part 1. Esophagus, 2023, 20(3): 343-372.
15.	Markar SR, Karthikesalingam A, Penna M, et al. Assessment of short-term clinical outcomes following salvage esophagectomy for the treatment of esophageal malignancy: systematic review and pooled analysis. Ann Surg Oncol, 2014, 21(3): 922-931.
16.	Kumagai K, Mariosa D, Tsai JA, et al. Systematic review and meta-analysis on the significance of salvage esophagectomy for persistent or recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy. Dis Esophagus, 2016, 29(7): 734-739.
17.	Faiz Z, Dijksterhuis WPM, Burgerhof JGM, et al. A meta-analysis on salvage surgery as a potentially curative procedure in patients with isolated local recurrent or persistent esophageal cancer after chemoradiotherapy. Eur J Surg Oncol, 2019, 45(6): 931-940.
18.	Markar S, Gronnier C, Duhamel A, et al. Salvage surgery after chemoradiotherapy in the management of esophageal cancer: is it a viable therapeutic option? J Clin Oncol, 2015, 33(33): 3866-3873.
19.	Saeki H, Sakai M, Watanabe T, et al. Salvage esophagectomy for unresectable locally advanced esophageal squamous cell carcinoma: significant or not? Ann Gastroenterol Surg, 2025, 9(5): 894-902.
20.	Sudo K, Xiao L, Wadhwa R, et al. Importance of surveillance and success of salvage strategies after definitive chemoradiation in patients with esophageal cancer. J Clin Oncol, 2014, 32(30): 3400-3405.
21.	Zhou N, Hofstetter WL, et al. Salvage esophagectomy definition influences comparative outcomes in esophageal squamous cell cancers. Ann Thorac Surg, 2022, 114(6): 2032-2040.
22.	Booka E, Haneda R, Ishii K, et al. Appropriate candidates for salvage esophagectomy of initially unresectable locally advanced T4 esophageal squamous cell carcinoma. Ann Surg Oncol, 2020, 27(9): 3163-3170.
23.	Harada H, Yamashita K, Katada C, et al. Patient selection for salvage surgery after definitive chemoradiotherapy in esophageal squamous cell carcinoma. Langenbecks Arch Surg, 2020, 405(6): 767-776.
24.	Kiyozumi Y, Yoshida N, Ishimoto T, et al. Prognostic factors of salvage esophagectomy for residual or recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy. World J Surg, 2018, 42(9): 2887-2893.
25.	D'Journo XB, Michelet P, Dahan L, et al. Indications and outcome of salvage surgery for oesophageal cancer. Eur J Cardiothorac Surg, 2008, 33(6): 1117-1123.
26.	Tsunoda S, Nishigori T, Okumura S, et al. Minimally invasive salvage esophagectomy following definitive chemoradiotherapy for esophageal cancer. Dis Esophagus, 2026, 39(2): doag026.
27.	Kingma BF, Grimminger PP, van der Sluis PC, et al. Worldwide techniques and outcomes in robot-assisted minimally invasive esophagectomy (RAMIE): results from the multicenter international registry. Ann Surg, 2022, 276(5): e386-e392.
28.	Mitchell KG, Nelson DB, Corsini EM, et al. Morbidity following salvage esophagectomy for squamous cell carcinoma: the MD Anderson experience. Dis Esophagus, 2020, 33(3): doz067.
29.	Watanabe M, Mine S, Nishida K, et al. Salvage esophagectomy after definitive chemoradiotherapy for patients with esophageal squamous cell carcinoma: who really benefits from this high-risk surgery? Ann Surg Oncol, 2015, 22(13): 4438-4444.
30.	Mayanagi S, Haneda R, Inoue M, et al. Selective lymphadenectomy for salvage esophagectomy in patients with esophageal squamous cell carcinoma. Ann Surg Oncol, 2022, 29(8): 4863-4870.
31.	Mine S, Tanaka K, Kawachi H, et al. Japanese classification of esophageal cancer, 12th edition: part Ⅰ. Esophagus, 2024, 21(3): 179-215.
32.	Miyata H, Yamasaki M, Miyazaki Y, et al. Clinical importance of supraclavicular lymph node metastasis after neoadjuvant chemotherapy for esophageal squamous cell carcinoma. Ann Surg, 2015, 262(2): 280-285.
33.	Tachimori Y, Ozawa S, Numasaki H, et al. Supraclavicular node metastasis from thoracic esophageal carcinoma: a surgical series from a Japanese multi-institutional nationwide registry of esophageal cancer. J Thorac Cardiovasc Surg, 2014, 148(4): 1224-1229.
34.	Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
35.	Kalff MC, Fransen LFC, de Groot EM, et al. Long-term survival after minimally invasive versus open esophagectomy for esophageal cancer: a nationwide propensity-score matched analysis. Ann Surg, 2022, 276(6): e749-e757.
36.	Boerner T, Harrington C, Tan KS, et al. Waiting to operate: the risk of salvage esophagectomy. Ann Surg, 2023, 277(5): 781-788.
37.	Ishiyama K, Oguma J, Kubo K, et al. Salvage minimally invasive esophagectomy after definitive chemoradiotherapy for esophageal cancer can improve postoperative complications compared with salvage open esophagectomy. Surg Endosc, 2022, 36(5): 3504-3510.
38.	Hirose W, Taniyama Y, Fujishima F, et al. Salvage esophagectomy for local recurrent esophageal cancer after definitive chemoradiotherapy followed by photodynamic therapy: a case report. Int J Surg Case Rep, 2021, 80: 105617.
39.	Wang S, Tachimori Y, Hokamura N, et al. Prognostic analysis of salvage esophagectomy after definitive chemoradiotherapy for esophageal squamous cell carcinoma: the importance of lymphadenectomy. J Thorac Cardiovasc Surg, 2014, 147(6): 1805-1811.
40.	Ohkura Y, Ueno M, Iizuka T, et al. Prognostic factors and appropriate lymph node dissection in salvage esophagectomy for locally advanced T4 esophageal cancer. Ann Surg Oncol, 2019, 26(1): 209-216.
41.	Chidi AP, Etchill EW, Ha JS, et al. Effect of thoracic versus cervical anastomosis on anastomotic leak among patients who undergo esophagectomy after neoadjuvant chemoradiation. J Thorac Cardiovasc Surg, 2020, 160(4): 1088-1095.
42.	Tachimori Y, Kanamori N, Uemura N, et al. Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg, 2009, 137(1): 49-54.
43.	Booka E, Takeuchi H, Morita Y, et al. What is the best reconstruction procedure after esophagectomy? A meta-analysis comparing posterior mediastinal and retrosternal approaches. Ann Gastroenterol Surg, 2023, 7(4): 553-564.
44.	李勇, 楊弘, 房渝, 等. 食管癌胸骨后路徑隔離管狀胃的SAFER手術體系建立及131例手術效果分析. 中華腫瘤雜志, 2025, 47(12): 1269-1276.Li Y, Yang H, Fang Y, et al. Establishment of the SAFER low-risk, high-quality surgical system for esophageal cancer: an analysis of 131 cases. Chin J Oncol, 2025, 47(12): 1269-1276.
45.	Ishikawa Y, Nishikawa K, Takahashi K, et al. Additional microvascular anastomosis to gastric conduit during esophagectomy reduces anastomotic leaks: propensity score weighting study. Ann Surg Oncol, 2023, 30(2): 874-881.
46.	Shimada Y, Okumura T, Nagata T, et al. Usefulness of blood supply visualization by indocyanine green fluorescence for reconstruction during esophagectomy. Esophagus, 2011, 8(4): 259-266.
47.	Sakuraba M, Kimata Y, Hishinuma S, et al. Importance of additional microvascular anastomosis in esophageal reconstruction after salvage esophagectomy. Plast Reconstr Surg, 2004, 113(7): 1934-1939.
48.	Takeda FR, Tutihashi R, Tustumi F, et al. Supercharged cervical anastomosis for esophagectomy and gastric pull-up. J Thorac Cardiovasc Surg, 2021, 162(3): 688-697.
49.	Kuriyama K, Okamura A, Hayami M, et al. Is prophylactic lymph node dissection efficacious in salvage esophagectomy after definitive chemoradiotherapy? Dis Esophagus, 2025, 38(1): doaf004.

1. Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). JAMA, 1999, 281(17): 1623-1627.
2. Swisher SG, Wynn P, Putnam JB, et al. Salvage esophagectomy for recurrent tumors after definitive chemotherapy and radiotherapy. J Thorac Cardiovasc Surg, 2002, 123(1): 175-183.
3. Katano A, Yamashita H, Nakagawa K. Re-irradiation of locoregional esophageal cancer recurrence following definitive chemoradiotherapy: a report of 6 cases. Mol Clin Oncol, 2017, 7(4): 681-686.
4. Jamel S, Markar SR. Salvage esophagectomy: safe therapeutic strategy? J Thorac Dis, 2017, 9(Suppl 8): S799-S808.
5. Nishimura Y, Suzuki M, Nakamatsu K, et al. Prospective trial of concurrent chemoradiotherapy with protracted infusion of 5-fluorouracil and cisplatin for T4 esophageal cancer with or without fistula. Int J Radiat Oncol Biol Phys, 2002, 53(1): 134-139.
6. Ishida K, Ando N, Yamamoto S, et al. Phase Ⅱ study of cisplatin and 5-fluorouracil with concurrent radiotherapy in advanced squamous cell carcinoma of the esophagus: a Japan Esophageal Oncology Group (JEOG)/Japan Clinical Oncology Group trial (JCOG9516). Jpn J Clin Oncol, 2004, 34(10): 615-619.
7. Tomblyn MB, Goldman BH, Thomas CR, et al. Cetuximab plus cisplatin, irinotecan, and thoracic radiotherapy as definitive treatment for locally advanced, unresectable esophageal cancer: a phase-Ⅱ study of the SWOG (S0414). J Thorac Oncol, 2012, 7(5): 906-912.
8. Higuchi K, Komori S, Tanabe S, et al. Definitive chemoradiation therapy with docetaxel, cisplatin, and 5-fluorouracil (DCF-R) in advanced esophageal cancer: a phase 2 trial (KDOG 0501-P2). Int J Radiat Oncol Biol Phys, 2014, 89(4): 872-879.
9. Satake H, Tahara M, Mochizuki S, et al. A prospective, multicenter phase Ⅰ/Ⅱ study of induction chemotherapy with docetaxel, cisplatin and fluorouracil (DCF) followed by chemoradiotherapy in patients with unresectable locally advanced esophageal carcinoma. Cancer Chemother Pharmacol, 2016, 78(1): 91-99.
10. Hihara J, Hamai Y, Emi M, et al. Role of definitive chemoradiotherapy using docetaxel and 5-fluorouracil in patients with unresectable locally advanced esophageal squamous cell carcinoma: a phase Ⅱ study. Dis Esophagus, 2016, 29(8): 1115-1120.
11. Park S, Oh D, Choi YL, et al. Durvalumab and tremelimumab with definitive chemoradiotherapy for locally advanced esophageal squamous cell carcinoma. Cancer, 2022, 128(11): 2148-2158.
12. Yi Q, Liu C, Cui Y, et al. Chemoradiotherapy with paclitaxel liposome plus cisplatin for locally advanced esophageal squamous cell carcinoma: a retrospective analysis. Cancer Med, 2023, 12(6): 6477-6487.
13. Meunier B, Raoul J, Le Prisé E, et al. Salvage esophagectomy after unsuccessful curative chemoradiotherapy for squamous cell cancer of the esophagus. Dig Surg, 1998, 15(3): 224-226.
14. Kitagawa Y, Ishihara R, Ishikawa H, et al. Esophageal cancer practice guidelines 2022 edited by the Japan Esophageal Society: part 1. Esophagus, 2023, 20(3): 343-372.
15. Markar SR, Karthikesalingam A, Penna M, et al. Assessment of short-term clinical outcomes following salvage esophagectomy for the treatment of esophageal malignancy: systematic review and pooled analysis. Ann Surg Oncol, 2014, 21(3): 922-931.
16. Kumagai K, Mariosa D, Tsai JA, et al. Systematic review and meta-analysis on the significance of salvage esophagectomy for persistent or recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy. Dis Esophagus, 2016, 29(7): 734-739.
17. Faiz Z, Dijksterhuis WPM, Burgerhof JGM, et al. A meta-analysis on salvage surgery as a potentially curative procedure in patients with isolated local recurrent or persistent esophageal cancer after chemoradiotherapy. Eur J Surg Oncol, 2019, 45(6): 931-940.
18. Markar S, Gronnier C, Duhamel A, et al. Salvage surgery after chemoradiotherapy in the management of esophageal cancer: is it a viable therapeutic option? J Clin Oncol, 2015, 33(33): 3866-3873.
19. Saeki H, Sakai M, Watanabe T, et al. Salvage esophagectomy for unresectable locally advanced esophageal squamous cell carcinoma: significant or not? Ann Gastroenterol Surg, 2025, 9(5): 894-902.
20. Sudo K, Xiao L, Wadhwa R, et al. Importance of surveillance and success of salvage strategies after definitive chemoradiation in patients with esophageal cancer. J Clin Oncol, 2014, 32(30): 3400-3405.
21. Zhou N, Hofstetter WL, et al. Salvage esophagectomy definition influences comparative outcomes in esophageal squamous cell cancers. Ann Thorac Surg, 2022, 114(6): 2032-2040.
22. Booka E, Haneda R, Ishii K, et al. Appropriate candidates for salvage esophagectomy of initially unresectable locally advanced T4 esophageal squamous cell carcinoma. Ann Surg Oncol, 2020, 27(9): 3163-3170.
23. Harada H, Yamashita K, Katada C, et al. Patient selection for salvage surgery after definitive chemoradiotherapy in esophageal squamous cell carcinoma. Langenbecks Arch Surg, 2020, 405(6): 767-776.
24. Kiyozumi Y, Yoshida N, Ishimoto T, et al. Prognostic factors of salvage esophagectomy for residual or recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy. World J Surg, 2018, 42(9): 2887-2893.
25. D'Journo XB, Michelet P, Dahan L, et al. Indications and outcome of salvage surgery for oesophageal cancer. Eur J Cardiothorac Surg, 2008, 33(6): 1117-1123.
26. Tsunoda S, Nishigori T, Okumura S, et al. Minimally invasive salvage esophagectomy following definitive chemoradiotherapy for esophageal cancer. Dis Esophagus, 2026, 39(2): doag026.
27. Kingma BF, Grimminger PP, van der Sluis PC, et al. Worldwide techniques and outcomes in robot-assisted minimally invasive esophagectomy (RAMIE): results from the multicenter international registry. Ann Surg, 2022, 276(5): e386-e392.
28. Mitchell KG, Nelson DB, Corsini EM, et al. Morbidity following salvage esophagectomy for squamous cell carcinoma: the MD Anderson experience. Dis Esophagus, 2020, 33(3): doz067.
29. Watanabe M, Mine S, Nishida K, et al. Salvage esophagectomy after definitive chemoradiotherapy for patients with esophageal squamous cell carcinoma: who really benefits from this high-risk surgery? Ann Surg Oncol, 2015, 22(13): 4438-4444.
30. Mayanagi S, Haneda R, Inoue M, et al. Selective lymphadenectomy for salvage esophagectomy in patients with esophageal squamous cell carcinoma. Ann Surg Oncol, 2022, 29(8): 4863-4870.
31. Mine S, Tanaka K, Kawachi H, et al. Japanese classification of esophageal cancer, 12th edition: part Ⅰ. Esophagus, 2024, 21(3): 179-215.
32. Miyata H, Yamasaki M, Miyazaki Y, et al. Clinical importance of supraclavicular lymph node metastasis after neoadjuvant chemotherapy for esophageal squamous cell carcinoma. Ann Surg, 2015, 262(2): 280-285.
33. Tachimori Y, Ozawa S, Numasaki H, et al. Supraclavicular node metastasis from thoracic esophageal carcinoma: a surgical series from a Japanese multi-institutional nationwide registry of esophageal cancer. J Thorac Cardiovasc Surg, 2014, 148(4): 1224-1229.
34. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet, 2012, 379(9829): 1887-1892.
35. Kalff MC, Fransen LFC, de Groot EM, et al. Long-term survival after minimally invasive versus open esophagectomy for esophageal cancer: a nationwide propensity-score matched analysis. Ann Surg, 2022, 276(6): e749-e757.
36. Boerner T, Harrington C, Tan KS, et al. Waiting to operate: the risk of salvage esophagectomy. Ann Surg, 2023, 277(5): 781-788.
37. Ishiyama K, Oguma J, Kubo K, et al. Salvage minimally invasive esophagectomy after definitive chemoradiotherapy for esophageal cancer can improve postoperative complications compared with salvage open esophagectomy. Surg Endosc, 2022, 36(5): 3504-3510.
38. Hirose W, Taniyama Y, Fujishima F, et al. Salvage esophagectomy for local recurrent esophageal cancer after definitive chemoradiotherapy followed by photodynamic therapy: a case report. Int J Surg Case Rep, 2021, 80: 105617.
39. Wang S, Tachimori Y, Hokamura N, et al. Prognostic analysis of salvage esophagectomy after definitive chemoradiotherapy for esophageal squamous cell carcinoma: the importance of lymphadenectomy. J Thorac Cardiovasc Surg, 2014, 147(6): 1805-1811.
40. Ohkura Y, Ueno M, Iizuka T, et al. Prognostic factors and appropriate lymph node dissection in salvage esophagectomy for locally advanced T4 esophageal cancer. Ann Surg Oncol, 2019, 26(1): 209-216.
41. Chidi AP, Etchill EW, Ha JS, et al. Effect of thoracic versus cervical anastomosis on anastomotic leak among patients who undergo esophagectomy after neoadjuvant chemoradiation. J Thorac Cardiovasc Surg, 2020, 160(4): 1088-1095.
42. Tachimori Y, Kanamori N, Uemura N, et al. Salvage esophagectomy after high-dose chemoradiotherapy for esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg, 2009, 137(1): 49-54.
43. Booka E, Takeuchi H, Morita Y, et al. What is the best reconstruction procedure after esophagectomy? A meta-analysis comparing posterior mediastinal and retrosternal approaches. Ann Gastroenterol Surg, 2023, 7(4): 553-564.
44. 李勇, 楊弘, 房渝, 等. 食管癌胸骨后路徑隔離管狀胃的SAFER手術體系建立及131例手術效果分析. 中華腫瘤雜志, 2025, 47(12): 1269-1276.Li Y, Yang H, Fang Y, et al. Establishment of the SAFER low-risk, high-quality surgical system for esophageal cancer: an analysis of 131 cases. Chin J Oncol, 2025, 47(12): 1269-1276.
45. Ishikawa Y, Nishikawa K, Takahashi K, et al. Additional microvascular anastomosis to gastric conduit during esophagectomy reduces anastomotic leaks: propensity score weighting study. Ann Surg Oncol, 2023, 30(2): 874-881.
46. Shimada Y, Okumura T, Nagata T, et al. Usefulness of blood supply visualization by indocyanine green fluorescence for reconstruction during esophagectomy. Esophagus, 2011, 8(4): 259-266.
47. Sakuraba M, Kimata Y, Hishinuma S, et al. Importance of additional microvascular anastomosis in esophageal reconstruction after salvage esophagectomy. Plast Reconstr Surg, 2004, 113(7): 1934-1939.
48. Takeda FR, Tutihashi R, Tustumi F, et al. Supercharged cervical anastomosis for esophagectomy and gastric pull-up. J Thorac Cardiovasc Surg, 2021, 162(3): 688-697.
49. Kuriyama K, Okamura A, Hayami M, et al. Is prophylactic lymph node dissection efficacious in salvage esophagectomy after definitive chemoradiotherapy? Dis Esophagus, 2025, 38(1): doaf004.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Chinese expert consensus on salvage esophagectomy for esophageal cancer after definitive chemoradiotherapy

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