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. 2022 Aug;114(2):418-425.
doi: 10.1016/j.athoracsur.2021.07.101. Epub 2021 Sep 10.

Treatment of Anastomotic Recurrence After Esophagectomy

Rebecca A Carr  1 , Caitlin Harrington  1 , Elvira Vos  1 , Manjit S Bains  1 , Matthew J Bott  1 , James M Isbell  1 , Bernard J Park  1 , Smita Sihag  1 , David R Jones  1 , Daniela Molena  2
Affiliations

Treatment of Anastomotic Recurrence After Esophagectomy

Rebecca A Carr et al. Ann Thorac Surg. 2022 Aug.

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.

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Conflict of interest statement

Conflicts of Interest: Matthew J. Bott is a consultant for AstraZeneca. James M. Isbell has stock ownership in LumaCyte and is a consultant/advisory board member for Roche Genentech. Bernard J. Park has served as a proctor for Intuitive Surgical and a consultant for COTA. David R. Jones serves as a consultant for AstraZeneca and on a Clinical Trial Steering Committee for Merck. Daniela Molena serves as a consultant for Johnson & Johnson, Urogen, and Boston Scientific. There are no other conflicts.

Figures

Figure 1.
Figure 1.
Overall survival (OS) after recurrence among the 46 patients with isolated local recurrence, according to the specific treatment approach used for recurrence. Treatment of local recurrence was classified into three groups so that patients were stratified as receiving no treatment, isolated local or systemic treatment, or combined local and systemic treatment.
See this image and copyright information in PMC

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Supplementary concepts