Abstract
ObjectiveThe aim of this study was to analyze the profile of tumor recurrence for patients operated on for cancer of oesophagogastric junction or oesophagus by Ivor-Lewis oesophagectomy.MethodsPatients undergoing potentially curative Ivor-Lewis oesophageal resection between January 1999 to December 2008 at a single center institution were retrospectively analyzed. Their clinical records, details of surgical procedure, postoperative course, pathological findings, recurrence and long term survival were reviewed retrospectively. Univariate and multivariate survival analyses were performed.ResultsOne hundred and twenty patients were analyzed. Fifty three patients (44%) presented recurrence during median follow-up of 58 months. Five-year relapse free survival (RFS) rate was 51% (95%CI = [46; 65%]). On multivariate analysis, pT stage > 2 (HR = 2.42, 95%CI = [1.22; 4.79] p = 0.011), positive lymph node status (HR = 3.69; 95% CI = [1.53; 8.96] p = 0.004) and lymph node ratio > 0.2 (HR = 2.57; 95%CI = [1.38; 4.76] p = 0.003) were associated with a poorer RFS and their combination was correlated to relapse risk. Moreover, preoperative tumor stenosis was associated with an increased risk of local recurrence (HR = 3.46; 95% CI = [1.38; 8.70] p = 0.008) whereas poor or undifferentiated tumor was associated with an increased risk of distant recurrence (HR = 3.32; 95% CI = [1.03; 10.04] p = 0.044).ConclusionpT stage > 2, positive lymph node status and lymph node ratio > 0.2 are independent prognostic factors of recurrence after Ivor-Lewis surgery for cancer. Their combination is correlated with an increasing risk of recurrence that may argue favorably, in addition with preoperative tumor stenosis assessment, for adjuvant treatment or reinforced follow-up.
Highlights
Oesophageal cancer is a major public health concern as it is the fourth cause of cancer death after lung, colorectal and prostate cancers
Ultrasonographic endoscopy (EUS) was performed on 62 patients and lymph node invasion was suspected in 62% of cases (n = 38)
Positron emission tomography (PET) was performed in 20 patients (16%)
Summary
Oesophageal cancer is a major public health concern as it is the fourth cause of cancer death after lung, colorectal and prostate cancers. In spite of optimal R0 resection, overall 5-year survival is poor, about 20 to 30%, because of frequent tumor recurrence [1]. Exclusive chemoradiotherapy has become an alternative to surgical treatment, with a comparable overall survival in locally advanced squamous cell carcinoma [2,3]. Ratio between adenocarcinoma and squamous cell carcinoma incidence is changing with an increasing incidence of adenocarcinoma developed on Barrett oesophagus in Western countries [4]. Study of tumor relapse could allow adaptation and targeting perioperative treatment to patients with high risk of recurrence. The aim of this study was to analyze the profile of tumor recurrence in a homogenous group of patients operated on for cancer of oesophagogastric junction or oesophagus by Ivor-Lewis oesophagectomy
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