Salvage surgery for esophageal squamous cell carcinoma after proton beam chemoradiotherapy shows significant morbidity but no operative mortality, indicating careful patient selection is crucial.

• In a study of 19 patients, major morbidity was reported in 47.3% post-salvage surgery, with a median overall survival of 16.2 months.
• The 1-, 3-, and 5-year overall survival rates were 68.0%, 43.1%, and 35.9%, respectively.

Surgeons should weigh the high risk of complications against potential survival benefits when considering salvage surgery in these patients.