Pattern of Recurrence after Extended Radical Esophagectomy with Three‐Field Lymph Node Dissection for Squamous Cell Carcinoma in the Thoracic Esophagus

Abstract

Factors responsible for recurrence of esophageal cancer were investigated in 90 patients who underwent extended radical esophagectomy with three-field dissection for a squamous cell carcinoma in the thoracic esophagus. The initial tumor recurrence was grouped as either locoregional (site of the primary tumor, anastomotic site, or lymph nodes) or as distant (distant organs, pleura, or peritoneum). Nineteen patients (21%) developed a locoregional recurrence, and 19 (21%) developed a distant recurrence. One (1%) developed both recurrences simultaneously and was classified as a distant recurrence. The locoregional recurrence was correlated with the stage factors, particularly the number of metastasis-positive nodes. For the distant recurrence, vascular invasion was found to have been the most important prognostic factor. Our findings suggested that locoregional recurrence was due to tumor progress related to the extent of lymph node metastasis, whereas distant recurrence was due to the oncologic behavior of the tumor. Locoregional recurrence in patients with limited disease may be reduced by extended radical esophagectomy with three-field dissection. Distant recurrence cannot be controlled by surgery. Adopted postoperative adjuvant therapies showed no effect on recurrence.

Factors influencing the risk of recurrence in patients with esophageal carcinoma treated with surgery: A single institution analysis consisting of 1002 cases

“…A large proportion of patients do not survive due to disease recurrence either at the surgical site or at extrathoracic sites. The overall recurrence rate following curative surgery ranges from 34-79%, while the locoregional, distant and both locoregional and distant recurrence rates range from 21-68, 18-63 and 5-47%, respectively (4,5,(8)(9)(10). In the present study, the rate of tumor recurrence was similar to the findings mentioned previously in such a Chinese TESCC population treated with surgery.…”

“…However, the majority of patients do not survive due to recurrence, even in the presence of radical resection and extended lymph node dissection. Numerous factors affect recurrence, including age, gender, tumor location, local tumor stage, degree of cell differentiation and the presence of lymph node metastases or vascular involvement (4)(5)(6). The knowledge of patterns of recurrence and its prevalence will be of great value in the clinic when designing therapeutic strategies, as it would provide evidence for determination of the extent of surgical resection and guide effective post-operative adjuvant therapy.…”

Detection of lymph node metastasis of oesophageal cancer by RT-nested PCR for SCC antigen gene mRNA

“…The lymph node metastasis, as well as the depth of penetration (Skinner et al, 1982), and the surgical curability (Roder et al, 1994), is regarded as an important prognostic factor in oesophageal cancer (Sugimachi et al, 1986;Siewert and Roder, 1992;Kato et al, 1993;Baba et al, 1994Baba et al, , 1997Fahn et al, 1994;Nishimaki et al, 1994;Bhansali et al, 1997). Recent development of molecular biology makes it possible to detect occult tumour cells and the influence of occult tumour cells has become evident.…”

“…Of patients who undergo curative surgery, 13.6-51% of patients relapse within 5 years (Abe et al, 1990;Fahn et al, 1994;Morita et al, 1994;Law et al, 1996;Bhansali et al, 1997). Therefore accurate evaluation of cancer spread is desirable to assess both the risk of recurrence and the prognosis.…”

“…In oesophageal cancer, as in many other malignancies, lymph node metastasis is an important prognostic factor (Skinner et al, 1982;Sugimachi et al, 1986;Siewert and Roder, 1992;Kato et al, 1993;Baba et al, 1994Baba et al, , 1997Fahn et al, 1994;Roder et al, 1994;Nishimaki et al, 1994;Bhansali et al, 1997). Of patients who undergo curative surgery, 13.6-51% of patients relapse within 5 years (Abe et al, 1990;Fahn et al, 1994;Morita et al, 1994;Law et al, 1996;Bhansali et al, 1997).…”