Salvage surgery after curative chemoradiotherapy for cT4 thoracic esophageal cancer is the only treatment that can be expected to cure, but the incidence of postoperative complications is also high, and its indication and timing should be carefully considered. In our hospital, radical chemoradiotherapy was positively performed for cT4 chest esophageal cancer, and salvage surgery was positively performed. Methods We examined 24 salvage surgery cases after chemo radiotherapy for cT4 esophageal cancer, which was conducted at our hospital from April 2012 to June 2018. The effect of treatment is determined after radical chemoradiotherapy. In the case of PR/SD, salvage surgery or salvage surgery is performed after additional chemotherapy. Salvage surgery was actively considered when it was considered resectable and resistant. In cases where CR was obtained, salvage surgery was performed in cases where relapse was observed during the course. Invasion organs were 9 cases of aorta, 11 cases of tracheobronchial, and 4 cases of others. Results No hospital deaths.Postoperative complications were 50%. Pneumonia 21%, anastomotic leak 13%. The period from the start of radical chemoradiotherapy to salvage surgery was 2.2 to 17.0 months (median 3.8 months). Grade 3 was observed in 4 cases. The 3-year OS was 80%, and the 3-year PFS was 43%. The recurrence rate of cT4b (Ao) was 75%, and that of cT4b (tracheobronchial) was 57%. In addition, the recurrence rate was high in the cases that were cN (+) and all the cases had postoperative recurrence in the cases that were pN (+) in the histopathological examination after salvage surgery. Conclusion Since cT4 was down-staged and enabled for radical surgery, dCRT could eventually be a powerful preoperative treatment. There was no death at the hospital, and postoperative complications are considered acceptable.Consideration of multidisciplinary treatment for patients with positive lymph node metastasis is needed. There are not a few cases of pCR, and surgical indications and informed consent are more important.

中文翻译：

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210 CT4 胸食管癌确定性放化疗后的抢救手术

cT4胸段食管癌根治性放化疗后抢救性手术是唯一有望治愈的治疗方法，但术后并发症发生率也较高，应慎重考虑其适应证和时机。我院cT4胸食管癌行根治性放化疗阳性，抢救性手术阳性。方法 对2012年4月至2018年6月在我院进行的cT4食管癌放化疗后挽救性手术病例24例进行检查，在根治性放化疗后进行疗效评价。在 PR/SD 的情况下，在额外化疗后进行抢救手术或抢救手术。当认为可切除和耐药时，积极考虑抢救手术。在获得CR的情况下，在过程中观察到复发的情况下进行抢救手术。侵犯器官为主动脉9例，气管支气管11例，其他4例。结果无住院死亡病例。术后并发症发生率为50%。肺炎 21%，吻合口漏 13%。从根治性放化疗开始到抢救手术的时间为2.2～17.0个月（中位3.8个月）。4例观察到3级。3 年 OS 为 80%，3 年 PFS 为 43%。cT4b（Ao）的复发率为75%，cT4b（气管支气管）的复发率为57%。此外，cN（+）的病例复发率高，挽救性手术后组织病理学检查为pN（+）的病例均出现术后复发。结论 由于 cT4 被降级并能够进行根治性手术，dCRT 最终可能成为一种强有力的术前治疗。院内无死亡病例，术后并发症可接受。淋巴结转移阳性患者需考虑多学科综合治疗。pCR的病例不在少数，手术指征和知情同意更为重要。