Recurrence of intrathoracic esophageal cancer

We have investigated the site of recurrence after resection of esophageal cancer in a total of 147 cases, which were examined and classified according to the site as follows: lymph nodes, organs, local sites, remnant of the esophagus, and peritoneum. The highest incidence of recurrence was 40% in both lymph nodes and organs. Recurrence was found frequently in the cervical and upper mediastinal lymph nodes. Careful examination should be made in the abdominal paraaortic lymph nodes. As for recurrence in organs, high rates were observed in lung, liver and bone; 70% of the recurrences in these organs were combined with simultaneous metastasis in other organs. In our examination of autopsied cases with local recurrence, the cancer was revealed as a tumor mass covering extensively each side of the posterior mediastinum. At the same time pleural dissemination was frequently observed. In the cases involving recurrence in the remnant esophagus, the disease-free interval was about 18 months--longer than the interval before recurrence in any other site. Peritoneal recurrence appeared in the patients with middle thoracic esophageal cancer. The prognosis following recurrence was extremely bad, with only a few exceptions: the survival period after recurrence was 8 months if it was in the lymph nodes, and an average of 4 months for other types of recurrence. The survival period was only 2 months after peritoneal recurrence.