To evaluate the safety and efficacy of salvage esophagectomy.

A retrospective analysis of 18 consecutive cases of salvage esophagectomy after definitive chemoradiotherapy (dCRT) by the single operation group in the department of thoracic surgery, Shanghai Chest Hospital affiliated to Shanghai Jiao Tong University from December 2014 to March 2017.

There were 6 cases (33.3%) and 12 cases (66.7%) of recurrent and persistent tumor after dCRT respectively. All the patients were treated with McKeown operation style combing thoracic and abdominal lymph nodes dissection. Among them, there were 15 cases of gastric esophagus and 3 cases of colon esophagus. Radical resection (R0) was performed in 12 cases, palliative resection (R2) in 6 cases. There were 4 cases of pathological complete response (pCR). The incidence of postoperative complications was 61.1% (11/18), including 6 cases of pulmonary infection, 4 cases of anastomotic leak, 2 cases of incision infection, 1 case of respiratory insufficiency, 1 case of recurrent laryngeal nerve paralysis, 1 case of chylothorax, 1 case of aortic bleeding caused by empyema. One patient died in perioperative period because of aortic bleeding due to empyema. The follow-up period was from 2 to 26 months, and the median follow-up time was 9 months. There were 13 patients survived and 5 patients died at the last follow-up date including 1 case died in perioperative period, 2 cases died of local-regional recurrence and metastasis respectively.

Salvage esophagectomy is a treatment option for the recurrent or persistent disease after dCRT, but the incidence of postoperative complications is high. Accurate clinical staging is especially important after dCRT and ycT4, ycN⁺ patients should be avoided. R0 resection and recurrence after long disease free period are favorable prognostic factors.