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Paul H. Schipper
Stephen D. Cassivi
Claude Deschamps
David C. Rice
Francis C. Nichols, III
Mark S. Allen
Peter C. Pairolero
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Right arrow Esophagus - cancer

Ann Thorac Surg 2005;80:1001-1006
© 2005 The Society of Thoracic Surgeons

Original article: General thoracic

Locally Recurrent Esophageal Carcinoma: When is Re-Resection Indicated?

Paul H. Schipper, MD, Stephen D. Cassivi, MD * , Claude Deschamps, MD, David C. Rice, MD, Francis C. Nichols, III, MD, Mark S. Allen, MD, Peter C. Pairolero, MD

Division of General Thoracic Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota

Accepted for publication March 23, 2005.

* Address reprint requests to Dr Cassivi, Division of General Thoracic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Email: cassivi.stephen{at}mayo.edu).

Presented at the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: Limited locally recurrent esophageal carcinoma is rare, and little is known regarding effectiveness of re-resection.

METHODS: Medical records of 27 consecutive patients with locally recurrent esophageal carcinoma who underwent reoperation at our institution between February 1974 and January 2003 were analyzed.

RESULTS: The original and recurrent cancer cell types were identical in all patients. Median disease-free interval was 19.4 months (range, 2.5 to 170 months). Recurrence was at the anastomosis in 23 patients (85%), esophageal remnant in 3 (11%), and stomach in 1 (4%). Ten patients had completion gastrectomy and partial esophagectomy, and 9 had resection of the anastomosis. The remaining 8 patients were found intraoperatively to have unresectable disease and underwent biopsy only. Re-resection was complete in 15 of the 19 patients resected (79%). Four patients had microscopic cancer at the resection margins. Reconstruction was with colon in 10 patients and esophagogastrostomy in 9. There were 2 deaths (operative mortality, 7%). Complications occurred in 16 patients (59%). Arrhythmia and anastomotic leak were the most common complications and each occurred in 7 patients (26%). Factors favorably associated with survival were disease-free interval greater than 2 years (p ≤ 0.05) and complete re-resection (p ≤ 0.02). Two-, three-, and five-year survival for patients completely re-resected was 62%, 44%, and 35%, respectively. Survival for patients who had incomplete re-resections was 18% at 2 years and zero at 3 years.

CONCLUSIONS: Re-resection of locally recurrent esophageal carcinoma is associated with considerable morbidity. However, long-term survival is possible in patients with a long disease-free interval or a complete re-resection.






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