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Surgical Outcomes in Esophageal Cancer Patients with Tumor Recurrence After Curative Esophagectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

This study aimed to identify predictive factors and to evaluate appropriate treatments for recurrence of esophageal cancer after curative esophagectomy. About 166 consecutive patients, who underwent curative esophagectomy, were enrolled between April 1994 and March 2003. Recurrence was classified as loco-regional or distant. Logistic regression analysis was used to identify predictive factors for recurrence. Prognostic factors were evaluated by Log-rank test and Cox proportional hazard regression analysis. The disease-specific 5-year survival was 56.8%. Recurrence was observed in 72 patients (43.4%), with 64 of these occurring within 3 years. The number of metastatic lymph nodes and lymphatic invasion independently predicted recurrence. There were significant differences in time to recurrence and survival time between loco-regional, distant recurrence, and combined recurrence. The 5-year survival time in patients with recurrence was 11.9%, and median survival time was 24 months. There was also a significant difference in survival after recurrence between treatment methods (no treatment vs chemo-radiotherapy, p = 0.0063; chemotherapy, p = 0.0247; and radiotherapy, p < 0.0001). Meticulous, long-term follow-up is particularly necessary in patients with four or more metastatic lymph nodes to achieve early detection of recurrence. Randomized controlled trials should be used to develop effective modalities for each recurrence pattern to improve therapeutic outcomes.

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References

  1. Daly JM, Fray WA, Little AG, Winchester DP, McKee RF, Stewart AK, Fremgen AM. Esophageal cancer: results of an American College of Surgeons patient care evaluation study. J Am Coll Surg. 2000;190:562–573.

    Article  PubMed  CAS  Google Scholar 

  2. Lerut T, Nafteux P, Moons J, Coosemans W, Decker G, De Leyn P, Van Raemdonck D, Ectors N. Three-field lymphadenectomy for carcinoma of the esophagus and gastroesophageal junction in 174 R0 resections: impact on staging, disease-free survival, and outcome: a plea for adaptation of TNM classification in upper-half esophageal carcinoma. Ann Surg. 2004;240:962–974.

    Article  PubMed  CAS  Google Scholar 

  3. Isono K, Ochiai T, Okuyama K, Onoda S. The treatment of lymph node metastasis esophageal cancer by extensive lymphadenectomy. Jpn J Surg. 1990;20:151–157.

    Article  PubMed  CAS  Google Scholar 

  4. Baba M, Aikou T, Yoshinaka H, Natsugoe S, Fukumoto T, Shimazu H, Akazawa K. Long-term results of subtotal esophagectomy with three-field lymphadenectomy for carcinoma of the thoracic esophagus. Ann Surg. 1994;219:310–316.

    Article  PubMed  CAS  Google Scholar 

  5. Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg. 1994;220:364–372.

    Article  PubMed  CAS  Google Scholar 

  6. Law S, Wong J. Two-field dissection is enough for esophageal cancer. Dis Esophagus. 2001;14:98–103.

    Article  PubMed  CAS  Google Scholar 

  7. Kunisaki C, Shimada H, Akiyama H, Nomura M, Matsuda G, Ono H. Prognostic factors in esophageal cancer. Hepato-gastroenterol. 2004;51:736–740.

    Google Scholar 

  8. Osugi H, Takemura M, Takada N, Hirohashi K, Kinoshita H, Higashino M. Prognostic factors after oesophagectomy and extended lymphadenectomy for squamous oesophageal cancer. Br J Surg. 2002;89:909–913.

    Article  PubMed  CAS  Google Scholar 

  9. Wijnhoven BP, Tran KT, Esterman A, Watson DI, Tilanus HW. An evaluation of prognostic factors and tumor staging of resected carcinoma of the esophagus. Ann Surg. 2007;245:717–725.

    Article  PubMed  Google Scholar 

  10. Urba SG, Orringer MB, Turrisi A, Iannettoni M, Forastiere A, Strawderman M. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol. 2001;19:305–313.

    PubMed  CAS  Google Scholar 

  11. Burmeister BH, Smithers BM, Gebski V, Fitzgerald L, Simes RJ, Devitt P, Ackland S, Gotley DC, Joseph D, Millar J, North J, Walpole ET, Denham JW, Trans-Tasman Radiation Oncology Group, Australasian Gastro-Intestinal Trials Group. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol. 2005;6:659–668.

    Article  PubMed  Google Scholar 

  12. Pouliquen X, Levard H, Hay JM, McGee K, Fingerhut A, Langlois-Zantin O. 5-Fluorouracil and cisplatin therapy after palliative surgical resection of squamous cell carcinoma of the esophagus. A multicenter randomized trial. French Associations for Surgical Research. Ann Surg. 1996;223:127–133.

    Article  PubMed  CAS  Google Scholar 

  13. Ando N, Iizuka T, Ide H, Ishida K, Shinoda M, Nishimaki T, Takiyama W, Watanabe H, Isono K, Aoyama N, Makuuchi H, Tanaka O, Yamana H, Ikeuchi S, Kabuto T, Nagai K, Shimada Y, Kinjo Y, Fukuda H. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan Clinical Oncology Group Study–JCOG9204. J Clin Oncol. 2003;21:4592–4596.

    Article  PubMed  Google Scholar 

  14. Mariette C, Balon JM, Piessen G, Fabre S, Van Seuningen I, Triboulet JP. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer. 2003;97:1616–1623.

    Article  PubMed  Google Scholar 

  15. Dresner SM, Griffin SM. Pattern of recurrence following radical oesophagectomy with two-field lymphadenectomy. Br J Surg. 2000;87:1426–1433.

    Article  PubMed  CAS  Google Scholar 

  16. Tachibana M, Kinugasa S, Yoshimura H, Shibakita M, Tonomoto Y, Dhar DK, Nagasue N. Clinical outcomes of extended esophagectomy with three-field lymph node dissection for esophageal squamous cell carcinoma. Am J Surg. 2005;189:98–109.

    Article  PubMed  Google Scholar 

  17. Shimada H, Kitabayashi H, Nabeya Y, Okazumi S, Matsubara H, Funami Y, Miyazawa Y, Shiratori T, Uno T, Itoh H, Ochiai T. Treatment response and prognosis of patients after recurrence of esophageal cancer. Surgery. 2003;133:24–31.

    Article  PubMed  Google Scholar 

  18. Sobin LH, Wittekind CH. TNM: Classification of Malignant Tumours. 6th ed. New York: Wiley-Liss; 2002.

    Google Scholar 

  19. Japanese Society for Esophageal Disease. Guidelines for Clinical and Pathologic Studies on Carcinoma of the Esophagus. 9thth ed. Tokyo: Kanehara; 2001.

    Google Scholar 

  20. Chen G, Wang Z, Liu XY, Liu FY. Recurrence pattern of squamous cell carcinoma in the middle thoracic esophagus after modified Ivor-Lewis esohagectomy. World J Surg. 2007;31:1107–1114.

    PubMed  Google Scholar 

  21. Fujita H, Sueyoshi S, Tanaka T, Shirouzu K. Three-field dissection for squamous cell carcinoma in the thoracic esophagus. Ann Thorac Cardiovasc Surg. 2002;8:328–335.

    PubMed  Google Scholar 

  22. Altorki N, Kent M, Ferrara C, Port J. Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg. 2002;236:177–183.

    Article  PubMed  Google Scholar 

  23. Nakagawa S, Kanda T, Kosugi S, Ohashi M, Suzuki T, Hatakeyama K. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg. 2004;198:205–211.

    Article  PubMed  Google Scholar 

  24. Osugi H, Takemura M, Higashino M, Takada N, Lee S, Ueno M, Tanaka Y, Fukuhara K, Hashimoto Y, Fujiwara Y, Kinoshita H. Causes of death and pattern of recurrence after esophagectomy and extended lymphadenectomy for squamous cell carcinoma of the thoracic esophagus. Oncol Rep. 2003;10:81–87.

    PubMed  Google Scholar 

  25. O’sullivan GC, Sheehan D, Clarke A, Stuart R, Kelly J, Kiely MD, Walsh T, Collins JK, Shanahan F. Micrometastases in esophagogastric cancer: high detection rate in resected rib segments. Gastroenterology. 1999;116:543–548.

    Article  PubMed  CAS  Google Scholar 

  26. Ajani J, Bekaii-Saab T, Gibson MK, Osarogiagbon RU. NCCN practice guidelines for esophageal cancer (Version 2.2007). http://www.nccn.org.

  27. Gondi V, Bradley K, Mehta M, Howard A, Khuntia D, Ritter M, Tomé W. Impact of hybrid fluorodeoxyglucose positron-emission tomography/computed tomography on radiotherapy planning in esophageal and non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2007;67:187–195.

    PubMed  Google Scholar 

  28. Wong WL, Chambers RJ. Role of PET/PET CT in the staging and restaging of thoracic oesophageal cancer and gastro-oesophageal cancer: a literature review. Abdom Imaging 2007 DOI 10.1007/s00261-007-9241-1.

  29. Kitagawa Y, Kitajima M. Gastrointestinal cancer and sentinel node navigation surgery. J Surg Oncol. 2002;79:188–193.

    Article  PubMed  Google Scholar 

  30. Arima H, Natsugoe S, Uenosono Y, Arigami T, Ehi K, Yanagita S, Higashi H, Ishigami S, Hokita S, Aikou T. Area of nodal metastasis and radioisotope uptake in sentinel nodes of upper gastrointestinal cancer. J Surg Res. 2006;135:250–254.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Gastroenterological Center, Yokohama City University, 4-57, Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan

    Chikara Kunisaki, Hirochika Makino, Ryo Takagawa, Naoto Yamamoto, Yasuhiko Nagano & Syoichi Fujii

  2. Department of Gastroenteorlogical Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan

    Takashi Kosaka, Hidetaka A. Ono, Yuichi Otsuka, Hirotoshi Akiyama, Yasushi Ichikawa & Hiroshi Shimada

Authors
  1. Chikara Kunisaki
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  2. Hirochika Makino
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  3. Ryo Takagawa
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  4. Naoto Yamamoto
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  5. Yasuhiko Nagano
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  6. Syoichi Fujii
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  7. Takashi Kosaka
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  8. Hidetaka A. Ono
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  9. Yuichi Otsuka
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  10. Hirotoshi Akiyama
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  11. Yasushi Ichikawa
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  12. Hiroshi Shimada
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Correspondence to Chikara Kunisaki.

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Kunisaki, C., Makino, H., Takagawa, R. et al. Surgical Outcomes in Esophageal Cancer Patients with Tumor Recurrence After Curative Esophagectomy. J Gastrointest Surg 12, 802–810 (2008). https://doi.org/10.1007/s11605-007-0385-7

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  • DOI: https://doi.org/10.1007/s11605-007-0385-7

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