Abstract
BackgroundSeveral studies have reported the efficacy of resection for recurrent lesions. However, they involved a limited number of subjects. This study aimed to identify a subset of patients who benefit from surgical resection of recurrent lesions after curative esophagectomy for esophageal squamous cell carcinoma.MethodsClinicopathological features of 186 patients with esophageal squamous cell carcinoma who underwent surgical treatment for postoperative recurrent lesions at 37 accredited institutions of the Japanese Esophageal Society were evaluated.ResultsThe most common recurrence site was the lymph node (106 cases; 58.6%), followed by the lung (40 cases; 22.1%). Univariate analyses revealed that pN 0–1 at esophagectomy (P = 0.0348), recurrence-free interval of ≥ 550 days (P = 0.0306), R0 resection (P < 0.0001), and absence of severe complications after resection for recurrent lesions (Clavien–Dindo grade < IIIa) (P = 0.0472) were associated with better overall survival after surgical resection. According to multivariate analyses, pN 0–1 (P = 0.0146), lung metastasis (P = 0.0274), recurrence-free interval after curative esophagectomy of ≥ 550 days (P = 0.0266), R0 resection (P = 0.0009), and absence of severe complications after resection for recurrent lesions (Clavien–Dindo grade < IIIa) (P = 0.0420) were independent predictive factors for better overall survival.ConclusionsSurgical resection of recurrent esophageal squamous cell carcinoma lesions is a useful option, especially for cases involving lower pN stage, lung metastasis, long recurrence-free intervals after esophagectomy, and technically resectable lesions. Surgical risks should be minimized as much as possible.
Highlights
Recurrence after radical surgery (R0 resection) for esophageal cancer occurs in 28–47% of patients in Japan [1], and several studies performed in Western countries have reported recurrence rates of > 50% [2,3,4]
Several studies have demonstrated the efficacy of lymphadenectomy for localized lymph node (LN) recurrence, such as cervical LNs, but these studies were performed at a single center or involved only a limited number of cases [6,7,8,9,10]
When recurrence occurs in a localized region or regions after radical surgery for esophageal cancer, surgery, chemoradiotherapy, and radiotherapy are considered treatments that can lead to radical cure [12]
Summary
Recurrence after radical surgery (R0 resection) for esophageal cancer occurs in 28–47% of patients in Japan [1], and several studies performed in Western countries have reported recurrence rates of > 50% [2,3,4]. When recurrence occurs in localized or resectable regions after radical esophagectomy, surgical resection, radiotherapy, and chemoradiotherapy are considered effective treatments [12]. This study aimed to identify a subset of patients who benefit from surgical resection of recurrent lesions after curative esophagectomy for esophageal squamous cell carcinoma. PN 0–1 (P = 0.0146), lung metastasis (P = 0.0274), recurrence-free interval after curative esophagectomy of ≥ 550 days (P = 0.0266), R0 resection (P = 0.0009), and absence of severe complications after resection for recurrent lesions (Clavien–Dindo grade < IIIa) (P = 0.0420) were independent predictive factors for better overall survival. Conclusions Surgical resection of recurrent esophageal squamous cell carcinoma lesions is a useful option, especially for cases involving lower pN stage, lung metastasis, long recurrence-free intervals after esophagectomy, and technically resectable lesions.
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