Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

The Prognostic Value of Oligo-Recurrence Following Esophagectomy for Esophageal Cancer

  • Minsang Kang (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Woojung Kim (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Chang Hyun Kang (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Kwon Joong Na (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Samina Park (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Hyun Joo Lee (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • In Kyu Park (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital) ;
  • Young Tae Kim (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital)
  • Received : 2023.04.17
  • Accepted : 2023.07.17
  • Published : 2023.11.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The concept of oligo-recurrence has not been generally applied in esophageal cancer. This study aimed to determine the prognostic significance of the number of recurrences in esophageal cancer. Methods: Patients with squamous cell carcinoma who underwent curative esophagectomy with R0 or R1 resection and who experienced a confirmed recurrence were included. The study included 321 eligible participants from March 2001 to December 2019. The relationship between the number of recurrences and post-recurrence survival was investigated. Results: The mean age was 63.8±8.1 years, and the majority of the participants (97.5%) were men. The median time to recurrence was 10.7 months, and the median survival time after recurrence was 8.8 months. Multiple recurrences with simultaneous local, regional, and distant locations were common (38%). In terms of the number of recurrences, single recurrences were the most common (38.3%) and had the best post-recurrence survival rate (median, 17.1 months; p<0.001). Patients with 2 or 3 recurrences showed equivalent survival to each other and longer survival than those with 4 or more (median, 9.4 months; p<0.001). In the multivariable analysis, the significant predictors of post-recurrence survival were body mass index, minimally invasive esophagectomy, N stage, R0 resection, post-recurrence treatment, and the number of recurrences (p<0.05). Conclusion: After esophagectomy, the number of recurrences was the most significant risk factor influencing post-recurrence survival in patients with esophageal cancer. In esophageal cancer, oligo-recurrence can be defined as a recurrence with three or fewer metastases. More intensive treatment might be recommended if oligo-recurrence occurs.

Keywords

References

  1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209-49. https://doi.org/10.3322/caac.21660 
  2. Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet 2013;381:400-12. https://doi.org/10.1016/S0140-6736(12)60643-6 
  3. Little AG, Lerut AE, Harpole DH, et al. The Society of Thoracic Surgeons practice guidelines on the role of multimodality treatment for cancer of the esophagus and gastroesophageal junction. Ann Thorac Surg 2014;98:1880-5. https://doi.org/10.1016/j.athoracsur.2014.07.069 
  4. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 2012;366:2074-84. https://doi.org/10.1056/NEJMoa1112088 
  5. Nakagawa S, Kanda T, Kosugi S, Ohashi M, Suzuki T, Hatakeyama K. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg 2004;198:205-11. https://doi.org/10.1016/j.jamcollsurg.2003.10.005 
  6. Law SY, Fok M, Wong J. Pattern of recurrence after oesophageal resection for cancer: clinical implications. Br J Surg 1996;83:107-11. https://doi.org/10.1002/bjs.1800830134 
  7. Abate E, DeMeester SR, Zehetner J, et al. Recurrence after esophagectomy for adenocarcinoma: defining optimal follow-up intervals and testing. J Am Coll Surg 2010;210:428-35. https://doi.org/10.1016/j.jamcollsurg.2010.01.006 
  8. Bhansali MS, Fujita H, Kakegawa T, et al. Pattern of recurrence after extended radical esophagectomy with three-field lymph node dissection for squamous cell carcinoma in the thoracic esophagus. World J Surg 1997;21:275-81. https://doi.org/10.1007/s002689900228 
  9. Blom RL, Lagarde SM, van Oudenaarde K, et al. Survival after recurrent esophageal carcinoma has not improved over the past 18 years. Ann Surg Oncol 2013;20:2693-8. https://doi.org/10.1245/s10434-013-2936-3 
  10. Mariette C, Balon JM, Piessen G, Fabre S, Van Seuningen I, Triboulet JP. Pattern of recurrence following complete resection of esophageal carcinoma and factors predictive of recurrent disease. Cancer 2003;97:1616-23. https://doi.org/10.1002/cncr.11228 
  11. Dresner SM, Griffin SM. Pattern of recurrence following radical oesophagectomy with two-field lymphadenectomy. Br J Surg 2000;87:1426-33. https://doi.org/10.1046/j.1365-2168.2000.01541.x 
  12. Shimada H, Kitabayashi H, Nabeya Y, et al. Treatment response and prognosis of patients after recurrence of esophageal cancer. Surgery 2003;133:24-31. https://doi.org/10.1067/msy.2003.31 
  13. Kunisaki C, Makino H, Takagawa R, et al. Surgical outcomes in esophageal cancer patients with tumor recurrence after curative esophagectomy. J Gastrointest Surg 2008;12:802-10. https://doi.org/10.1007/s11605-007-0385-7 
  14. Osugi H, Takemura M, Takada N, Hirohashi K, Kinoshita H, Higashino M. Prognostic factors after oesophagectomy and extended lymphadenectomy for squamous oesophageal cancer. Br J Surg 2002;89:909-13. https://doi.org/10.1046/j.1365-2168.2002.02109.x 
  15. Depypere L, Moons J, Lerut T, et al. Prognostic value of the circumferential resection margin and its definitions in esophageal cancer patients after neoadjuvant chemoradiotherapy. Dis Esophagus 2018;31. https://doi.org/10.1093/dote/dox117 
  16. Okada N, Fujii S, Fujita T, et al. The prognostic significance of the positive circumferential resection margin in pathologic T3 squamous cell carcinoma of the esophagus with or without neoadjuvant chemotherapy. Surgery 2016;159:441-50. https://doi.org/10.1016/j.surg.2015.06.044 
  17. Kang CH, Hwang Y, Lee HJ, Park IK, Kim YT. Risk factors for local recurrence and optimal length of esophagectomy in esophageal squamous cell carcinoma. Ann Thorac Surg 2016;102:1074-80. https://doi.org/10.1016/j.athoracsur.2016.03.117 
  18. Hsu PK, Wang BY, Huang CS, Wu YC, Hsu WH. Prognostic factors for post-recurrence survival in esophageal squamous cell carcinoma patients with recurrence after resection. J Gastrointest Surg 2011;15:558-65. https://doi.org/10.1007/s11605-011-1458-1 
  19. Su XD, Zhang DK, Zhang X, Lin P, Long H, Rong TH. Prognostic factors in patients with recurrence after complete resection of esophageal squamous cell carcinoma. J Thorac Dis 2014;6:949-57. https://doi.org/10.3978/j.issn.2072-1439.2014.07.14 
  20. Parry K, Visser E, van Rossum PS, Mohammad NH, Ruurda JP, van Hillegersberg R. Prognosis and treatment after diagnosis of recurrent esophageal carcinoma following esophagectomy with curative intent. Ann Surg Oncol 2015;22 Suppl 3:S1292-300. https://doi.org/10.1245/s10434-015-4840-5 
  21. Kato H, Fukuchi M, Miyazaki T, et al. Classification of recurrent esophageal cancer after radical esophagectomy with two- or three-field lymphadenectomy. Anticancer Res 2005;25:3461-7. 
  22. Miyata H, Yamasaki M, Kurokawa Y, et al. Survival factors in patients with recurrence after curative resection of esophageal squamous cell carcinomas. Ann Surg Oncol 2011;18:3353-61. https://doi.org/10.1245/s10434-011-1747-7 
  23. Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol 1995;13:8-10. https://doi.org/10.1200/JCO.1995.13.1.8 
  24. Niibe Y, Kazumoto T, Toita T, et al. Frequency and characteristics of isolated para-aortic lymph node recurrence in patients with uterine cervical carcinoma in Japan: a multi-institutional study. Gynecol Oncol 2006;103:435-8. https://doi.org/10.1016/j.ygyno.2006.03.034 
  25. Niibe Y, Hayakawa K. Oligometastases and oligo-recurrence: the new era of cancer therapy. Jpn J Clin Oncol 2010;40:107-11. https://doi.org/10.1093/jjco/hyp167 
  26. Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012;379:1887-92. https://doi.org/10.1016/S0140-6736(12)60516-9 
  27. Mariette C, Markar SR, Dabakuyo-Yonli TS, et al. Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med 2019;380:152-62. https://doi.org/10.1056/NEJMoa1805101 
  28. van der Sluis PC, van der Horst S, May AM, et al. Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: a randomized controlled trial. Ann Surg 2019;269:621-30. https://doi.org/10.1097/SLA.0000000000003031 
  29. Gottlieb-Vedi E, Kauppila JH, Mattsson F, et al. Long-term survival in esophageal cancer after minimally invasive esophagectomy compared to open esophagectomy. Ann Surg 2022;276:e744-8. https://doi.org/10.1097/SLA.0000000000004645 
  30. Kobayashi N, Kohno T, Haruta S, et al. Pulmonary metastasectomy secondary to esophageal carcinoma: long-term survival and prognostic factors. Ann Surg Oncol 2014;21 Suppl 3:S365-9. https://doi.org/10.1245/s10434-014-3677-7 
  31. Kanamori J, Aokage K, Hishida T, et al. The role of pulmonary resection in tumors metastatic from esophageal carcinoma. Jpn J Clin Oncol 2017;47:25-31. https://doi.org/10.1093/jjco/hyw141 
  32. Ichida H, Imamura H, Yoshimoto J, et al. Pattern of postoperative recurrence and hepatic and/or pulmonary resection for liver and/or lung metastases from esophageal carcinoma. World J Surg 2013;37:398-407. https://doi.org/10.1007/s00268-012-1830-7