P1.171. Salvage Esophagectomy Outcomes After Neoadjuvant Chemoradiotherapy in Esophageal Squamous Cell Carcinoma: A 45-Patients Indian Single-Center Experience

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer The SANO trial demonstrated non-inferior 2-year overall survival with active surveillance versus immediate surgery in patients achieving clinical complete response after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer, with ~40% eventually requiring salvage esophagectomy for locoregional regrowth. Data on salvage outcomes in SCC-dominant Indian cohorts under resource-variable surveillance remain limited. Retrospective review of 45 consecutive patients with biopsy-proven esophageal squamous cell carcinoma undergoing salvage esophagectomy for persistent or recurrent locoregional disease after nCRT (CROSS regimen) at a high-volume Delhi center (2019–2025). Robotic approach in 33 (73%), open in 12 (27%). Primary endpoints: R0 resection rate, major morbidity (Clavien-Dindo ≥III), perioperative mortality, and survival. Median age 58 years, 71% male. Median time from nCRT completion to salvage surgery: 5.3 months (IQR 3.8–7.2). R0 resection achieved in 39 (87%); pathologic complete response in 8 (18%). Major complications occurred in 14 (31%), including anastomotic leak (20%, n=9) and pulmonary events (27%, n=12). In-hospital mortality 2% (n=1); 90-day mortality 7% (n=3). Median follow-up 28 months; 2-year overall survival 64%, 3-year overall survival 47%. Salvage esophagectomy in this Indian SCC series yielded high R0 rates, acceptable morbidity, low mortality, and survival comparable to SANO salvage subsets. Robotic techniques proved safe and feasible. These results support implementation of SANO-style active surveillance in SCC-predominant settings with prompt access to high-quality minimally invasive salvage surgery.