Treatment of anastomotic recurrence after esophagectomy Journal Article
| Authors: | Carr, R. A.; Harrington, C.; Vos, E.; Bains, M. S.; Bott, M. J.; Isbell, J. M.; Park, B. J.; Sihag, S.; Jones, D. R.; Molena, D. |
| Article Title: | Treatment of anastomotic recurrence after esophagectomy |
| Abstract: | Background: Isolated local recurrence after curative esophagectomy for esophageal cancer is a rare event. Although it is potentially curable, management can be challenging. Methods: We retrospectively reviewed all patients undergoing esophagectomy for esophageal adenocarcinoma (EAC) from 2000 to 2019. Date of recurrence was defined as the date at which the initial abnormal surveillance study result or symptomatic presentation led to further workup and subsequent pathologic diagnosis of recurrence. Overall survival after recurrence was estimated using Kaplan-Meier methods and compared between treatment groups using the log-rank test. Results: Of the 1370 patients with EAC who underwent esophagectomy in our cohort, 531 (39%) developed recurrence of their disease. The 5-year cumulative incidence of recurrence was 2.7% (95% CI, 2.0%-3.6%) for local, 6.3% (95% CI, 5.2%-7.8%) for regional, and 22.0% (95% CI, 20.0%-24.4%) for distant recurrences. On univariable and multivariable competing-risk regression analysis, advanced pT stage, signet ring histology, and serious complication were independently associated with local recurrence. Patients with local recurrence treated with definitive therapy had a median survival after recurrence of 19.1 months (95% CI, 11.4-33.2 months) compared with 10.6 months (95% CI, 8.5-14.2 months) for chemotherapy or radiotherapy alone and 1.73 months (95% CI, 0.23-15.6 months) for no treatment (P < .001). Conclusions: Isolated local recurrence occurred in only 3% of patients. Advanced T stage, signet cell histology, and serious complication were risk factors for recurrence. Although complex surgical resection is required, in very select cases, more aggressive treatment may be warranted. © 2022 The Society of Thoracic Surgeons |
| Keywords: | adult; cancer chemotherapy; controlled study; aged; cancer surgery; major clinical study; overall survival; systemic therapy; conference paper; cancer radiotherapy; cancer staging; antineoplastic agent; cancer diagnosis; cohort analysis; surgical approach; retrospective study; postoperative complication; recurrent disease; kaplan meier method; regression analysis; esophageal adenocarcinoma; esophagectomy; anastomosis leakage; cumulative incidence; cancer prognosis; esophagogastrostomy; lymph vessel metastasis; human; male; female |
| Journal Title: | Annals of Thoracic Surgery |
| Volume: | 114 |
| Issue: | 2 |
| ISSN: | 0003-4975 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2022-08-01 |
| Start Page: | 418 |
| End Page: | 425 |
| Language: | English |
| DOI: | 10.1016/j.athoracsur.2021.07.101 |
| PUBMED: | 34509415 |
| PROVIDER: | scopus |
| PMCID: | PMC8938857 |
| DOI/URL: | |
| Notes: | Conference Paper -- Export Date: 1 August 2022 -- Source: Scopus |
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