Systematic Review and Meta‐Analysis on the Efficacy and Safety of Salvage Esophagectomy for T4 Esophageal Squamous Cell Carcinoma

Background Salvage esophagectomy is associated with high morbidity and mortality rates. We performed a systematic review and meta‐analysis to evaluate the efficacy and safety of salvage esophagectomy for unresectable locally advanced (T4) esophageal squamous cell carcinoma (ESCC). Methods We searched the MEDLINE (PubMed) databases, the Cochrane Library databases, Ichushi‐Web (the databases of the Japan Medical Abstract Society), and CiNii (the Academic Information Search Service of the National Institute of Information from Japan) for articles on salvage esophagectomy for T4 ESCC. Results Eight studies (208 cases) were eligible for meta‐analysis. The overall postoperative complications rate (Clavien–Dindo grade ≥ III) was 30% (95% CI: 23–38, I 2 = 0%); anastomotic leak rate was 18% (95% CI: 13–25, I 2 = 15%); pulmonary complication rate was 31% (95% CI: 20–42, I 2 = 63%); mortality rate was 7% (95% CI: 3–11, I 2 = 0%); and R0 resection rate was 72% (95% CI: 59–83, I 2 = 72%). A meta‐analysis of survival was not performed due to heterogeneous reporting across studies. However, overall survival was reported to be higher in patients achieving R0 resection. Conclusions Salvage esophagectomy for cT4 ESCC is associated with significant morbidity, particularly a high anastomotic leak rate of 18%. The procedure should be reserved for carefully selected patients in whom R0 resection is highly feasible.