Case Western Reserve School of Medicine, Cleveland, Ohio.
Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio.
Ann Thorac Surg. 2022 Jul;114(1):211-217. doi: 10.1016/j.athoracsur.2021.10.021. Epub 2021 Nov 16.
Current guidelines for follow-up after esophagectomy suggest only history and physical examination (HPE). With recent advances in chemotherapy and immunotherapy for patients with recurrent esophageal cancer, we hypothesized that surveillance imaging (SI) would identify patients with cancer recurrence earlier and improve long-term survival.
A retrospective review of all patients undergoing esophagectomy for esophageal cancer at a single institution between 2007 and 2018 was conducted. Patients were categorized as recurrence detected through SI or recurrence detected through HPE alone. Patients were excluded if recurrence occurred within 3 months of esophagectomy.
During the study period, 225 esophageal cancer patients underwent an esophagectomy. Among these, 101 (44.9%) had SI and 124 (55.1%) had routine follow-up with HPE. There were 88 recurrences (39.1%) with median follow-up of 12 months. Rate of recurrence was similar based on screening method: 41 of 101 (40.6%) by SI and 47 of 124 (37.9%) by HPE (P = .68). Among patients with recurrence, recipients of additional treatment were also similar between groups, 36 of 41 (87.8%) by SI and 34 of 47 (72.3%) by HPE (P = .468). Among those who had a recurrence, the median overall survival was significantly longer in those undergoing SI at 23 months compared with those who received HPE at 16 months (P = .047).
SI after esophagectomy is not associated with improved detection of recurrence, but is associated with improved overall survival once recurrence is detected. These data suggest that earlier identification of esophageal cancer recurrence may have survival benefit. Standardizing SI may prove beneficial for patients after esophagectomy.
目前食管癌切除术后的随访指南仅建议进行病史和体检（HPE）。随着化疗和免疫治疗在复发性食管癌患者中的最新进展，我们假设监测影像学（SI）将更早地发现癌症复发，并改善长期生存。
对单中心 2007 年至 2018 年间接受食管癌切除术的所有患者进行回顾性分析。根据 SI 或单独 HPE 检测到的复发情况对患者进行分类。如果在食管癌切除术后 3 个月内发生复发，则将患者排除在外。
在研究期间，225 例食管癌患者接受了食管癌切除术。其中 101 例（44.9%）进行了 SI，124 例（55.1%）进行了常规 HPE 随访。中位随访 12 个月时，88 例（39.1%）发生了复发。根据筛查方法，复发率相似：SI 检测到 41 例（40.6%），HPE 检测到 47 例（37.9%）（P=0.68）。在有复发的患者中，SI 组和 HPE 组接受额外治疗的患者比例也相似，SI 组为 36 例（87.8%），HPE 组为 34 例（72.3%）（P=0.468）。在有复发的患者中，SI 组的总生存时间明显长于 HPE 组，分别为 23 个月和 16 个月（P=0.047）。
食管癌切除术后的 SI 并不能提高复发的检出率，但在检测到复发后与总体生存率的提高有关。这些数据表明，更早地识别食管癌复发可能具有生存获益。SI 的标准化可能对食管癌切除术后的患者有益。
