Characteristics and sequence of the recurrent patterns after curative esophagectomy for squamous cell carcinoma

A large number of patients with esophageal cancer experience recurrence, even when a curative operation is performed. The purpose of this study was to clarify the characteristics of recurrence after a curative esophagectomy.

The patterns and the time of recurrence after curative esophagectomy were examined in 187 cases of thoracic esophageal cancer. Ninety-five of these patients died of evident recurrence. The recurrence patterns were classified into lymphatic, hematogenic, mixed type (lymphatic and concomitant hematogenic), and intramural recurrences.

The number of cases in each recurrence group were 46, 23, 22, and 4, respectively. The disease free intervals were fairly closely correlated with pTNM stage in the lymphatic and mixed type groups whereas they were within 2 years in all cases of the hematogenic group. Among the 22 cases of the mixed type, hematogenic recurrence preceded lymphatic recurrence in only one case. Furthermore, 17 of 20 cases with either cervical or mediastinal lymph node recurrence of the mixed type were accompanied with lung recurrence, whereas the remaining two cases with abdominal lymph node recurrence had liver recurrence.

These findings suggest that most mixed type recurrences and most lymphatic ones are primarily caused by lymph node metastases; thus the importance of a radical lymphadenectomy was supported. On the other hand, a careful examination for hematogenic recurrence is essential soon after operation.