Patterns and Outcomes of Recurrent Esophageal Cancer After Curative Esophagectomy

• Published in: World journal of surgery 2017-09, Vol.41 (9), p.2337-2344
• Main Authors: Yamashita, Kotaro, Watanabe, Masayuki, Mine, Shinji, Kurogochi, Takanori, Okamura, Akihiko, Hayami, Masaru, Imamura, Yu
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adenocarcinoma - secondary; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Cancer; Carcinoma, Squamous Cell - secondary; Carcinoma, Squamous Cell - surgery; Cardiac Surgery; Combined Modality Therapy; Confidence intervals; Curative Resection; Disease-Free Survival; Distant Organ; Esophageal Cancer; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophageal Squamous Cell Carcinoma; Esophagectomy; Esophagus; Female; Gastrointestinal surgery; General Surgery; Health risk assessment; Humans; Lung Neoplasms - secondary; Lung Neoplasms - therapy; Lungs; Lymph; Lymph Node; Lymph nodes; Lymphatic Metastasis; Lymphatic system; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; Neoplasm Recurrence, Local - therapy; Original Scientific Report; Parameter identification; Patients; Prognosis; Retrospective Studies; Surgery; Survival; Survival Rate; Therapy; Thoracic Surgery; Time Factors; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-017-4024-5

Background The recurrence patterns and therapeutic outcomes of patients with recurrent esophageal cancer after curative esophagectomy are not fully understood. Methods Data on recurrence patterns and sites of recurrence in patients with recurrent esophageal cancer after curative esophagectomy from 2005 to 2015 were retrospectively analyzed. Time to recurrence after curative esophagectomy and survival after recurrence were compared among groups stratified by recurrence pattern and site. Multivariate analysis was performed to identify clinicopathological parameters influencing survival after recurrence. Results Of the 290 patients identified, a single pattern of recurrence occurred in 224 patients (77.2%) and a multiple pattern of recurrence occurred in 66 patients (22.8%). The most frequent recurrence pattern was lymph node in 173 patients (59.7%), followed by distant organ in 133 patients (45.9%). Median time to recurrence and median survival after recurrence of all patients were 228 and 327 days, respectively. Among patients with lymph node or lung recurrence, there were 5-year survivors after recurrence who underwent multimodal therapy. Multivariate analysis revealed that longer disease-free interval [hazard ratio (HR) 0.70, 95% confidence interval (95% CI) 0.52–0.93], single pattern of recurrence (HR 0.54, 95% CI 0.39–0.74), and curative treatment for recurrence (HR 0.17, 95% CI 0.10–0.28) were significantly associated with favorable prognosis. Conclusions Although the prognosis of recurrent esophageal cancer remains unfavorable, if multimodal treatment that includes local therapy was curative, prognosis could improve, especially in patients with lymph node or lung recurrence.