pan style='font-weight: bold'>Objective:pan> Some patients with localised oesophageal cancer are treated with definitive chemoradiotherapy (CRT) rather than surgery. A subset of these patients experiences local failure, relapse or treatment-related complication without distant metastases, with no other curative treatment option but salvage oesophagectomy. The aim of this study was to assess the benefit/risk ratio of surgery in such context. pan style='font-weight: bold'>Methods:pan> Review of a single institution experience with 24 patients: 18 men and 6 women, with a mean age of 59 years (±9). Histology was squamous cell carcinoma in 18 cases and adenocarcinoma in 6. Initial stages were cIIA (pan style='font-style: italic'>npan> = 5), cIIB (pan style='font-style: italic'>npan> = 1) and cIII (pan style='font-style: italic'>npan> = 18). CRT consisted of 2–6 sessions of the association 5-fluorouracil/cisplatin concomitantly with a 50–75 Gy radiation therapy. Salvage oesophagectomy was considered for the following reasons: relapse of the disease with conclusive (pan style='font-style: italic'>npan> = 11) or inconclusive biopsies (pan style='font-style: italic'>npan> = 7), intractable stenosis (pan style='font-style: italic'>npan> = 3), and perforation or severe oesophagitis (pan style='font-style: italic'>npan> = 3), at a mean delay of 74 days (14–240 days) following completion of CRT. pan style='font-weight: bold'>Results:pan> All patients underwent a transthoracic en-bloc oesophagectomy with 2-field lymphadenectomy. Thirty-day and 90-day mortality rates were 21%and 25%, respectively. Anastomotic leakage (pan style='font-style: italic'>ppan> = 0.05), cardiac failure (pan style='font-style: italic'>ppan> = 0.05), length of stay (pan style='font-style: italic'>ppan> = 0.03) and the number of packed red blood cells (pan style='font-style: italic'>ppan> = 0.02) were more frequent in patients who received more than 55 Gy, leading to a doubled in-hospital mortality when compared to that of patients having received lower doses. A R0 resection was achieved in 21 patients (87.5%). A complete pathological response (ypT0N0) was observed in 3 patients (12.5%). Overall and disease-free 5-year survival rates were 35%and 21%, respectively. There was no long-term survivor following R1–R2 resections. Functional results were good in more than 80%of the long-term survivors. pan style='font-weight: bold'>Conclusion:pan> Salvage surgery is a highly invasive and morbid operation after a volume dose of radiation exceeding 55 Gy. The indication must be carefully considered, with care taken to avoid incomplete resections. Given that long-term survival with a fair quality of life can be achieved, such high-risk surgery should be considered in selected patients at an experienced centre.

ass="h4">Aims

To evaluate a single centre's experience with pancreatic carcinoma focused on preoperative chemoradiation therapy (CRT) for treatment of locally advanced pancreatic carcinoma. The aim of the present analysis was to evaluate the median overall survival time (OS) after preoperative CRT and to compare it with OS after primary resection of pancreatic carcinoma. In conclusion a new treatment strategy was developed using multimodality treatment for pancreatic carcinoma deemed to be resectable by CT-scan.

ass="h4">Patients and methods

<p>Between 1995 and 2003, 302 patients with ductal adenocarcinoma of the pancreatic head and body were recorded prospectively and OS was analysed with regard to therapy.

ass="h4">Results

<p>Fifty-eight patients were resected without any pretreatment and had an OS of 21 months. Twenty-one patients with initially unresectable tumours underwent CRT followed by resection and had an OS of 54 months, which was not significantly different from primary resection (pan style='font-style: italic'>ppan>&#xa0;=&#xa0;0.315). Lymph node metastasis was significantly reduced after CRT (pan style='font-style: italic'>ppan>&#xa0;=&#xa0;0.0029). OS for patients whose tumours could not be resected was 3–10 months, depending on tumour stage and consecutive therapy.

ass="h4">Conclusion

<p>CRT pretreatment was effective in locally advanced pancreatic carcinoma and resulted in resection of tumours otherwise staged as non-resectable. This experience led to a randomized trial for patients who by CT are staged to have resectable cancer of the pancreatic head with the intent to increase curative resectability and survival by neoadjuvant CRT (ISRCTN78805636/NCT00335543).