Abstract
Background
Although imaging surveillance after esophagectomy is required to achieve long-term survival for patients with esophageal cancer, the optimal surveillance timing and interval remain unclear. This study was designed to investigate the differences in oncological outcomes based on the detection method for recurrence and surveillance interval in patients with recurrence detected by routine imaging examination after esophagectomy.
Methods
A total of 527 patients who underwent thoracic esophagectomy for esophageal cancer with R0 resection between 2003 and 2021 in our department were enrolled in this study. Postoperative, routine surveillance was conducted at an outpatient clinic every 3 months, thoracoabdominal computed tomography (CT) every 4–6 months, and esophagogastroduodenoscopy every 6 months. The detection method and optimal interval of imaging surveillance also were investigated.
Results
Of all patients, 161 patients developed recurrence during surveillance; 110 (68.3 %) by routine surveillance and 37 (23.0%) not detected by routine surveillance. Among patients who were diagnosed with recurrence following routine surveillance, patients with pStage IV disease on imaging surveillance by thoracoabdominal CT at an interval of ≤ 5 months had a better survival rate than those with an interval of 6 months (P = 0.004), whereas no significant difference among different intervals was observed in patients with pStage I–III disease.
Conclusions
Recurrence may have been detectable by our routine surveillance in approximately 70% of patients who developed recurrence. These findings demonstrate the necessity of different imaging surveillance intervals for different pStages of esophageal cancer.
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Acknowledgment
The authors thank Kumiko Motooka, a staff member at the Department of Surgery in Keio University School of Medicine, for her help with the preparation of this manuscript.
Funding
Dr. Kitagawa reports grants from TAIHO PHARMACEUTICAL CO., LTD.; CHUGAI PHARMACEUTICAL CO., LTD.; Yakult Honsha Co. Ltd.; DAIICHI SANKYO COMPANY; Merck Serono Co., Ltd; AsahiKASEI Co., Ltd; EA Pharma Co., Ltd.; Otsuka Pharmaceutical Co., Ltd.; Takeda Pharmaceutical Co., Ltd.; Otsuka Pharmaceutical Factory Inc.; SHIONOGI & CO., LTD.; KAKEN PHARMACEUTICAL CO., LTD.; Kowa Pharmaceutical Co., Ltd.; Astellas Pharma Inc.; MEDICON INC., DAINIPPON SUMITOMO PHARMA Co., Ltd.; Taisho Toyama Pharmaceutical Co., Ltd.; Kyouwa Hakkou Kirin Co., Ltd.; Pfizer Japan Inc.; ONO PHARMACEUTICAL CO., LTD.; NIHON PHARMACEUTICAL CO., LTD.; Japan Blood Products Organization; Medtronic Japan Co., Ltd.; Sanofi K.K.; Eisai Co., Ltd; TSUMURA & CO.; KCI Licensing, Inc.; ABBOTT JAPAN CO., LTD; and FUJIFILM Toyama Chemical Co., Ltd., outside the submitted work.
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Takeuchi, M., Kawakubo, H., Matsuda, S. et al. The Usability of Intensive Imaging Surveillance After Esophagectomy in Patients with Esophageal Cancer. Ann Surg Oncol 30, 2190–2197 (2023). https://doi.org/10.1245/s10434-022-12739-y
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DOI: https://doi.org/10.1245/s10434-022-12739-y