Surgical therapy for recurrent esophageal cancers at anastomoses after esophagectomy

The long-term prognosis of a recurrent esophageal cancer at the anastomosis after esophagectomy is generally unfavorable. We have experienced six cases in our institute where surgical treatment resulted in a good prognosis.

Between 1962 and 1997, 1720 patients underwent esophagectomy for esophageal cancers in our institute. Anastomotic recurrence was identified in 13 and surgical therapy was performed for six of these. Their clinical and histopathological features were examined with reference to control of anastomotic recurrent esophageal cancers.

The six patients were all males with an average age of 61.5 years. Their median disease-free interval was 5.5 months. Three patients lived more than five years after the first esophagectomy. Histopathologically, regional lymph node metastases were found in four of the cases and cervical lymph node metastases were detected in two at the initial esophagectomy. Vessel invasion was evident in three cases, intraepithelial spread in one, and multiple cancers in two. There were no cases with intramural metastasis. Radiotherapy and/or chemotherapy were added for three cases.

After esophagectomy for esophageal cancers, frequent examination of the anastomotic site using endoscopy and long-term follow-up studies are desirable. The option of surgery should not be ignored when a recurrent cancer appears only at the anastomosis.