Second primary malignancy in patients with long survival after esophagectomy for squamous cell carcinoma of the esophagus.

Abstract

42 Background: Patients after esophagectomy for esophageal squamous cell carcinoma (ESCC) were reported to have a remarkably high risk of subsequent cancer of head and neck cancer (Matsubara, et al. J Clin Oncol 2003). The outcome was reported to be significantly less favorable as a result of difficulty in early detection. However, magnifying endoscopy combined with narrow band imaging (NBI) system recently allowed early detection of head and neck cancer. This study was to assess the risk of subsequent malignancies after esophagectomy for ESCC for the establishment of an adequate follow-up program. Methods: Eighty patients with ESCC who had undergone radical esophagectomy at the Kawasaki Municipal Hospital from 2000 to 2006 were eligible for this study. Among the eighty patients, we analyzed 41 cases who survived more than 5 years after esophagectomy. Results: Median survival of the 41 patients was 7.1 years. Two patients who developed squamous cell carcinoma in the lung within 5 years after esophagectomy were not included in the group of subsequent second malignancies, because it was difficult to distinguish primary tumors from metastatic tumors. Second malignancies were found in 7 (17.1%) of 41 patients subjected to curative esophagectomy. Subsequent malignancies were most frequently found in the head and neck region (n = 4; 57.1%), followed by the residual esophagus (n = 1; 14.3%), colon (n = 1; 14.3%), and breast (n = 1; 14.3%). The subsequent cancers in head and neck, and residual esophagus were detected from 1 to 9 years after esophagectomy in an early stage with magnifying endoscopy combined with NBI system. They were curatively resected by endoscopic laryngo-pharyngeal surgery (ELPS) and endoscopic submucosal dissection (ESD). The subsequent cancers in colon and breast were also curatively resected by operation. Conclusions: Patients after esophagectomy for ESCC had a high risk of subsequent cancer of head and neck cancer. Minute postoperative surveillance with magnifying endoscopy combined with NBI system is strongly recommended even more than 5 years after esophagectomy. Early detection of second malignancies allowed less invasive treatment such as ELPS and ESD with favorable outcome.