Chinese expert consensus on salvage esophagectomy for esophageal cancer after definitive chemoradiotherapy
- VernacularTitle:根治性放化疗后食管癌挽救性切除术中国专家共识
- Author:
Zhaoxian LIN
1
;
Yang HU
2
;
Lei XIAN
3
;
Yun LI
4
;
Jinbo ZHAO
5
;
Xiaobin HOU
6
;
Shuangping ZHANG
7
;
Sunkui KE
8
;
Changying GUO
9
;
Songping XIE
10
;
Haitao WEI
11
;
Yong LI
12
Author Information
- Collective Name:Integrated Esophageal Cancer Committee of Chinese Anti-Cancer Association
- Publication Type:Journal Article
- Keywords: Salvage esophagectomy; definitive chemoradiotherapy; esophageal cancer; esophageal squamous cell carcinoma; retrosternal reconstruction; expert consensus
- From: Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2026;33(07):977-987
- CountryChina
- Language:Chinese
- Abstract: 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.
