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. 2022 Nov 1;276(5):806-813.
doi: 10.1097/SLA.0000000000005638. Epub 2022 Jul 26.

Recurrent Disease After Esophageal Cancer Surgery: A Substudy of The Dutch Nationwide Ivory Study

Marianne C Kalff  1 , Sofie P G Henckens  1 , Daan M Voeten  1 , David J Heineman  2 , Maarten C C M Hulshof  3 , Hanneke W M van Laarhoven  4 , Wietse J Eshuis  1 , Peter C Baas  5 , Renu R Bahadoer  6 , Eric J T Belt  7 , Baukje Brattinga  8 , Linda Claassen  9 , Admira Ćosović  10 , David Crull  11 , Freek Daams  2 , Annette D van Dalsen  12 , Jan Willem T Dekker  13 , Marc J van Det  11 , Manon Drost  7 , Peter van Duijvendijk  9 , Stijn van Esser  13 , Marcia P Gaspersz  14 , Burak Görgec  15 , Richard P R Groenendijk  14 , Henk H Hartgrink  6 , Erwin van der Harst  16 , Jan W Haveman  10 , Joos Heisterkamp  17 , Richard van Hillegersberg  18 , Wendy Kelder  5 , B Feike Kingma  18 , Willem J Koemans  19 , Ewout A Kouwenhoven  11 , Sjoerd M Lagarde  20 , Frederik Lecot  21 , Philip P van der Linden  22 , Misha D P Luyer  23 , Grard A P Nieuwenhuijzen  23 , Pim B Olthof  13 , Donald L van der Peet  2 , Jean-Pierre E N Pierie  8 , E G J M Robert Pierik  12 , Victor D Plat  2 , Fatih Polat  24 , Camiel Rosman  25 , Jelle P Ruurda  18 , Johanna W van Sandick  19 , Rene Scheer  10 , Cettela A M Slootmans  25 , Meindert N Sosef  21 , Odin V Sosef  21 , Wobbe O de Steur  6 , Hein B A C Stockmann  15 , Fanny J Stoop  24 , Guusje Vugts  23 , Guy H E J Vijgen  20 , Víola B Weeda  7 , Marinus J Wiezer  22 , Martijn G H van Oijen  4 , Mark I van Berge Henegouwen  1 , Suzanne S Gisbertz  1
Affiliations

Recurrent Disease After Esophageal Cancer Surgery: A Substudy of The Dutch Nationwide Ivory Study

Marianne C Kalff et al. Ann Surg. .

Abstract

Objective: This study investigated the patterns, predictors, and survival of recurrent disease following esophageal cancer surgery.

Background: Survival of recurrent esophageal cancer is usually poor, with limited prospects of remission.

Methods: This nationwide cohort study included patients with distal esophageal and gastroesophageal junction adenocarcinoma and squamous cell carcinoma after curatively intended esophagectomy in 2007 to 2016 (follow-up until January 2020). Patients with distant metastases detected during surgery were excluded. Univariable and multivariable logistic regression were used to identify predictors of recurrent disease. Multivariable Cox regression was used to determine the association of recurrence site and treatment intent with postrecurrence survival.

Results: Among 4626 patients, 45.1% developed recurrent disease a median of 11 months postoperative, of whom most had solely distant metastases (59.8%). Disease recurrences were most frequently hepatic (26.2%) or pulmonary (25.1%). Factors significantly associated with disease recurrence included young age (≤65 y), male sex, adenocarcinoma, open surgery, transthoracic esophagectomy, nonradical resection, higher T-stage, and tumor positive lymph nodes. Overall, median postrecurrence survival was 4 months [95% confidence interval (95% CI): 3.6-4.4]. After curatively intended recurrence treatment, median survival was 20 months (95% CI: 16.4-23.7). Survival was more favorable after locoregional compared with distant recurrence (hazard ratio: 0.74, 95% CI: 0.65-0.84).

Conclusions: This study provides important prognostic information assisting in the surveillance and counseling of patients after curatively intended esophageal cancer surgery. Nearly half the patients developed recurrent disease, with limited prospects of survival. The risk of recurrence was higher in patients with a higher tumor stage, nonradical resection and positive lymph node harvest.

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Conflict of interest statement

M.D.P.L. received research grants from Galvani and Medtronic. G.A.P.N. reports consulting fees and research grants from Medtronic. C.R. has received research grants from Johnson&Johnson and Medtronic. M.I.v.B.H. reports research grants from Olympus and Stryker, in addition to consulting fees from Medtronic, Alesi Surgical, Johnson&Johnson, and Mylan. M.G.H.v.O. has received unrestricted research grants from Bayer, Lilly, Merck Serono, Nordic, Servier, and Roche. The remaining authors report no conflicts of interest.

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