Treatment strategies for postoperative locoregional recurrent esophageal squamous cell carcinoma after curative resection: a narrative review

Recurrence following curative esophagectomy remains a major clinical challenge and is associated with poor prognosis. Treatment strategies for postoperative recurrent esophageal squamous cell carcinoma must be individualized based on recurrence patterns, prior treatment history, and patient-related factors. Locoregional recurrence and oligo-recurrence in some non-regional lymph nodes may still be amenable to curative-intent therapy, including salvage surgery and definitive chemoradiotherapy (CRT). Selection of optimal treatment should consider tumor burden, performance status, and prior radiation exposure. Salvage surgery offers favorable long-term outcomes in carefully selected patients, particularly when recurrence occurs in non-dissected regions. CRT remains a central treatment strategy for unresectable disease, whereas re-irradiation after prior radiotherapy carries a substantial risk of severe toxicity and requires cautious patient selection. Advances in radiotherapy techniques, including intensity-modulated radiotherapy and particle therapy, may improve therapeutic efficacy while reducing toxicity. In parallel, systemic therapies, particularly immune checkpoint inhibitors, have expanded treatment options; however, their role in locoregional recurrence remains to be fully defined. Importantly, prognostic factors should not only be considered descriptive variables but also integrated into clinical decision-making to distinguish candidates for curative versus palliative treatment. Future strategies integrating precision oncology and multimodal approaches are expected to further improve outcomes. Prospective studies are needed to establish optimal treatment algorithms.