Importance of long-term surveillance after curative esophagectomy for esophageal squamous cell carcinoma

Abstract

Summary Background The long-term outcomes after esophagectomy for esophageal cancer remain uncertain and the optimal surveillance strategy after curative surgery remains controversial. Methods In this study, the clinicopathological characteristics of patients who underwent curative thoracic esophagectomy between 1991 and 2015 at Toranomon Hospital were retrospectively analyzed and reviewed until December 2020. We evaluated the accumulated data regarding the pattern and rates of recurrence and second malignancy. Results A total of 1054 patients were eligible for inclusion in the study. Of these, 97% were followed up for 5 years, and the outcomes after 25 years could be determined in 65.5%. Recurrence was diagnosed in 318 patients (30.2%), and the most common pattern was lymph node metastasis (n = 168, 52.8%). Recurrence was diagnosed within 1 year in 174 patients (54.7%) and within 3 years in 289 (90.9%). Second malignancy possibly occurred through the entire study period after esophagectomy even in early-stage cancer, keeping 2%–5% of the incidental risk. There was no significant difference in the prognosis between 3-year survivors with and without a second malignancy. Conclusions Most recurrences after resection of esophageal cancer occurred within 3 years regardless of disease stage. However, these patients have an ongoing risk of developing a second malignancy after esophagectomy. Further consideration is required regarding the efficacy of long-term surveillance.

Effect of postoperative adjuvant chemotherapy on esophageal squamous cell carcinoma patients with lymphovascular invasion and without lymph node metastasis

“…In the present study, the 5-year OS rate was 40.9% and 41.6% in the AC and NC groups, respectively, which were lower than the 5-year OS rate of lymph node-negative (pN0) ESCC patients (75.6% vs 69.7% in the postoperative treatment and surgery alone groups, respectively) [23]. Bone metastasis and local LNM were the most common recurrence patterns, which are consistent with ndings from previous studies [24].…”

“…Distant metastasis was the main recurrence mode of these patients, which is much higher than the results of similar studies [24,34,35]. Maehara et al found that the level of vascular endothelial growth factor (VEGF) in tumor tissue of patients with LVI was higher.…”

“…For patients who developed esophageal cancer post-operation, the recurrence pattern could be divided into local recurrence and distant metastasis. Studies have shown that most patients with ESCC recurred within 3 years after surgery [24,33]. Local recurrence after surgery is the main recurrence mode for patients with negative lymph nodes.…”

Successful Robot-Assisted Surgery for Advanced Metachronous Cancer in a Gastric Conduit after Esophagectomy: A Case Report

“…The incidence of gastric tube cancer (metachronous cancer in the gastric conduit after esophagectomy) has increased owing to the improved survival rate of patients with esophageal cancer treated with esophagectomy. [1][2][3][4] In recent years, endoscopic treatments for early stage metachronous gastric carcinoma arising from the gastric conduit, such as endoscopic mucosal and submucosal dissections, have been successfully performed as minimally invasive treatments. 5) However, the indications for endoscopic treatment are limited to less-advanced tumors.…”