Abstract
Background
No standardized methods exist for the follow-up and treatment of recurrence after a curative esophagectomy for patients with thoracic esophageal cancers.
Methods
One hundred seventy-five patients with thoracic esophageal cancer underwent a curative resection and were followed up during a median period of 3.0 years (3 months-18 years). The time to recurrence, the first indicators (FIs) to suspect recurrence, and the factors predictive of prognosis after recurrence were investigated.
Results
Recurrence occurred in 72 (41.1%) of 175 patients. Forty (55.6%) and 22 (30.6%) of 72 cases presented with recurrences in the first and second year after the initial operation, respectively. Clinical visit (anamnesis and physical examination), tumor markers, and imaging were FIs in 39 (54.2%), 33 (45.8%), and 49 (68.1%) of 72 patients with recurrence, respectively. Imaging was the exclusive FI in 19 (26.4%) cases. A multivariate analysis showed the favorable prognostic factors after recurrence to be recurrence later than 1 year after the initial operation and a case in which the FI was only imaging.
Conclusions
Intensive follow-up is required in the first 2 years after surgery, and early detection of recurrence is important. The accumulation of clinical data based on a fixed schedule with consensus is necessary to obtain more definite evidence for the diagnosis and treatment of recurrent esophageal cancer.
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References
Ando N, Ozawa S, Kitagawa Y, Shinozawa Y, Kitajima M. Improvement in the results of surgical treatment of advanced squamous esophageal carcinoma during 15 consecutive years. Ann Surg 2000;232:225–232.
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 (Phila) 2003;97:1616–1623.
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.
Kato H, Fukuchi M, Miyazaki T, Nakajima M, Kimura H, Faried A, et al. Classification of recurrent esophageal cancer after radical esophagectomy with two- or three-field lymphadenectomy. Anticancer Res 2005;25:3461–3467.
Kuwano H, Nishimura Y, Ohtsu A, Kato H, Kitagawa Y, Tamai S, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus. April 2007 edition: part II. Esophagus 2008;5:117–132.
Ajani JA, Barthel JS, Bekaii-Saab T, Bentrem DJ, D’Amico TA, Fuchs CS, et al. Esophageal cancer. J Natl Compr Cancer Netw 2008;6:818–849.
Stahl M, Oliveira J. Esophageal cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009;20(suppl 4):32–33.
Dresner SM, Griffin SM. Pattern of recurrence following radical oesophagectomy with two-field lymphadenectomy. Br J Surg 2000;87:1426–1433.
Kyriazanos ID, Tachibana M, Shibakita M, Yoshimura H, Kinugasa S, Dhar DK, et al. Pattern of recurrence after extended esophagectomy for squamous cell carcinoma of the esophagus. Hepatogastroenterology 2003;50:115–120.
Toh Y, Sakaguchi Y, Ikeda O, Adachi E, Ohgaki K, Yamashita Y, et al. The triangulating stapling technique for cervical esophagogastric anastomosis after esophagectomy. Surg Today 2009;39:201–206.
Japan Esophageal Society. Japanese classification of esophageal cancer, 10th edition: part I. Esophagus 2009;6:1–25.
Japan Esophageal Society. Japanese classification of esophageal cancer, 10th edition: part II. Esophagus 2009;6:71–94.
Raoul JL, Le Prise E, Meunier B, Julienne V, Etienne PL, Gosselin M, et al. Combined radiochemotherapy for postoperative recurrence of oesophageal cancer. Gut 1995;37:174–176.
Kubota K, Kato H, Tachimori Y, Watanabe H, Yamaguchi H, Nakanishi Y, et al. Surgical therapy for recurrent esophageal cancers at anastomoses after esophagectomy. Hepatogastroenterology 2001;48:1364–1367.
Komatsu S, Shioaki Y, Ichikawa D, Hamashima T, Kan K, Ueshima Y, et al. Survival and clinical evaluation of salvage operation for cervical lymph node recurrence in esophageal cancer. Hepatogastroenterology 2005;52:796–799.
Kato H, Miyazaki T, Nakajima M, Fukuchi M, Manda R, Kuwano H. Value of positron emission tomography in the diagnosis of recurrent oesophageal carcinoma. Br J Surg 2004;91:1004–1009.
Teyton P, Metges JP, Atmani A, Jestin-Le Tallec V, Volant A, Visvikis D, et al. Use of positron emission tomography in surgery follow-up of esophageal cancer. J Gastrointest Surg 2009;13:451–458.
Sato Y, Motoyama S, Maruyama K, Okuyama M, Ogawa J. A second malignancy is the major cause of death among thoracic squamous cell esophageal cancer patients negative for lymph node involvement. J Am Coll Surg 2005;201:188–193.
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Toh, Y., Oki, E., Minami, K. et al. Follow-up and recurrence after a curative esophagectomy for patients with esophageal cancer: the first indicators for recurrence and their prognostic values. Esophagus 7, 37–43 (2010). https://doi.org/10.1007/s10388-009-0221-0
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DOI: https://doi.org/10.1007/s10388-009-0221-0