Recurrence pattern of oesophageal carcinoma after limited resection does not support wide local excision with extensive lymph node dissection.

Abstract

The recurrence pattern after 'limited' resection for oesophageal carcinoma was analysed to determine whether more extensive local excision of tumour in combination with radical lymphadenectomy improves locoregional disease control and long-term survival. A total of 143 patients who underwent limited surgery with curative intent between 1983 and 1989 were studied: 90 with squamous cell carcinoma (group 1) and 53 with adenocarcinoma (group 2) of the thoracic oesophagus. One patient was lost to follow-up. Tumour recurrence occurred in 40 patients (44 per cent) in group 1 and 35 (66 per cent) in group 2. Locoregional recurrence in isolation occurred in 11 per cent of patients in group 1 and 8 per cent of those in group 2; locoregional recurrence was detected in combination with tumour elsewhere in 19 and 28 per cent respectively. In conclusion, one-third of patients at the most might potentially have benefited from more radical local tumour resection. Theoretical advantages such as a prolonged disease-free interval and definite cure should be weighed against the higher risk of serious complications. More extensive procedures should therefore be performed only in controlled clinical studies.