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. 2013 Nov 21:8:215.
doi: 10.1186/1749-8090-8-215.

Recurrence risk after Ivor Lewis oesophagectomy for cancer

Mael Chalret du Rieu, Thomas Filleron, Benoit Beluchon, Marine Humeau, Charles-Henri Julio, Eric Bloom, Laurent Ghouti, Sylvain Kirzin, Guillaume Portier, Bernard Pradère, Nicolas Carrère  1
Affiliations

Recurrence risk after Ivor Lewis oesophagectomy for cancer

Mael Chalret du Rieu et al. J Cardiothorac Surg. .

Abstract

Objective: The aim of this study was to analyze the profile of tumor recurrence for patients operated on for cancer of oesophagogastric junction or oesophagus by Ivor-Lewis oesophagectomy.

Methods: Patients undergoing potentially curative Ivor-Lewis oesophageal resection between January 1999 to December 2008 at a single center institution were retrospectively analyzed. Their clinical records, details of surgical procedure, postoperative course, pathological findings, recurrence and long term survival were reviewed retrospectively. Univariate and multivariate survival analyses were performed.

Results: One hundred and twenty patients were analyzed. Fifty three patients (44%) presented recurrence during median follow-up of 58 months. Five-year relapse free survival (RFS) rate was 51% (95%CI = [46; 65%]). On multivariate analysis, pT stage > 2 (HR = 2.42, 95%CI = [1.22; 4.79] p = 0.011), positive lymph node status (HR = 3.69; 95% CI = [1.53; 8.96] p = 0.004) and lymph node ratio > 0.2 (HR = 2.57; 95%CI = [1.38; 4.76] p = 0.003) were associated with a poorer RFS and their combination was correlated to relapse risk. Moreover, preoperative tumor stenosis was associated with an increased risk of local recurrence (HR = 3.46; 95% CI = [1.38; 8.70] p = 0.008) whereas poor or undifferentiated tumor was associated with an increased risk of distant recurrence (HR = 3.32; 95% CI = [1.03; 10.04] p = 0.044).

Conclusion: pT stage > 2, positive lymph node status and lymph node ratio > 0.2 are independent prognostic factors of recurrence after Ivor-Lewis surgery for cancer. Their combination is correlated with an increasing risk of recurrence that may argue favorably, in addition with preoperative tumor stenosis assessment, for adjuvant treatment or reinforced follow-up.

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Figures

Figure 1
Figure 1
Kaplan-Meier Relapse Free Survival curve.
Figure 2
Figure 2
Kaplan-Meier Relapse Free Survival curves according to the number of risk factors (p < 0.001).
See this image and copyright information in PMC

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