Prognosis and Treatment After Diagnosis of Recurrent Esophageal Carcinoma Following Esophagectomy with Curative Intent

Abstract

BackgroundStrategies for the treatment of recurrence after initial curative esophagectomy are increasingly being recognized. The aim of this study was to identify prognostic factors that affect survival in patients with recurrence and to evaluate treatment strategies.MethodsA prospective database (2003–2013) was used to collect consecutive patients with esophageal carcinoma treated with initial curative esophagectomy. Locations, symptoms, and treatment of recurrence were registered. Post-recurrence survival was defined as the time between the first recurrence and death or last follow-up.ResultsOf the 335 selected patients, 171 (51 %) developed recurrence. Multivariable analysis identified distant recurrence as opposed to locoregional recurrence [hazard ratio (HR) 2.15, 95 % confidence interval (CI) 1.27–3.65; p = 0.005], more than three recurrent locations (HR 2.42, 95 % CI 1.34–4.34; p = 0.003), and treatment (HR 0.29, 95 % CI 0.20–0.44; p < 0.001) as independent prognostic factors associated with post-recurrence survival. Primary tumor characteristics, including neoadjuvant therapy, histological type, pTN stage, and radicality, did not independently influence post-recurrence survival. Treatment was initiated in 62 patients (37 %) and included chemotherapy, radiotherapy, and/or surgery. Median post-recurrence survival of all patients was 3.0 months (range 0–112). In total, six patients (4 %) were still disease-free following treatment, indicating cure.ConclusionsIn patients treated for esophageal cancer at curative intent, distant recurrence and more than three recurrent locations were independent prognostic factors associated with worse post-recurrence survival, irrespective of primary tumor characteristics. Although survival after recurrence was poor, treatment can prolong survival and can even lead to cure in selected patients.

Predictors of Survival After Treatment of Oligometastases After Esophagectomy

“…A growing body of literature continues to suggest that oligometastasis may represent tumors with more favorable biology and that these patients may benefit from an aggressive treatment approach aimed at the site of recurrence [13][14][15][16]. For example, several investigators have suggested that surgical treatment of oligometastatic nonsmall cell lung cancer may improve survival [16,17].…”

Subcutaneous metastases from early stage esophageal adenocarcinoma case report

“…It has been found that any form of treatment can significantly improve survival time in patients with oligometastases in the form of fewer than three metastases, although this may be biased by patient selection [18].…”

Postoperative infectious complications-driven recurrence after radical resection for esophageal cancer

“…This discrepancy was attributed to the fact that recurrent cases were treated with chemotherapy, meaning that the esophageal cancer death rate subsequently decreased. In previous studies focusing on recurrent esophageal cancer, chemotherapy improved the prognosis of recurrent disease [32][33][34].…”