Division of Thoracic and Upper Gastrointestinal Surgery, Montreal General Hospital, McGill University Health Centre, 1650 Cedar Avenue, Montreal, QC, Canada.
J Gastrointest Cancer. 2023 Dec;54(4):1292-1299. doi: 10.1007/s12029-023-00929-0. Epub 2023 Mar 29.
Locoregional recurrence of esophageal carcinoma after neoadjuvant therapy and en bloc esophagectomy, although uncommon, is challenging to manage. Currently, there are no standard treatment approaches prompting many health care providers to adopt a palliative approach. We describe our experience and outcomes of treating this specific group of patients with a focus on salvage curative intent local therapy.
All patients undergoing en bloc esophagectomy following neoadjuvant therapy between 2007 and 2017 at the McGill University Health Centre, a tertiary referral center for esophageal cancer, were identified. Patient follow-up included a structured surveillance protocol with serial endoscopic and cross-sectional imaging studies. Local recurrence was defined as histologically confirmed recurrences at the anastomosis. Regional recurrence was defined as radiological evidence of celiac, mediastinal, or para-esophageal/conduit lymphadenopathy. Demographic, pathologic, therapeutic variables were extracted as well as disease free and overall survival.
Of 755 patients identified, locoregional recurrences occurred in 27 patients (3.6%) of whom 18 were included in the analysis. The median disease-free survival post index operation was 15 months (IQR 10-23). The sites of recurrence were local (6/18, 33.3%); regional (8/18, 44.4%); and locoregional (4, 22.2%). Chemoradiation was the most common modality used to treat recurrence (10/18, 55.6%) whilst 4 (22.2%) underwent surgery. Following treatment for locoregional recurrence, 1-year overall survival was 61.1% and at 5 years was 22.2%.
Consolidative salvage local therapy for locoregional recurrence after en bloc esophagectomy is feasible and can entail prolonged survival in a subset of patients.
新辅助治疗和整块食管切除术后局部区域复发食管癌虽然不常见，但难以处理。目前，由于没有标准的治疗方法，许多医疗保健提供者采用姑息治疗方法。我们描述了我们治疗这一特定患者群体的经验和结果，重点是挽救性根治性局部治疗。
在麦吉尔大学健康中心（三级食管癌转诊中心），对 2007 年至 2017 年间接受新辅助治疗后行整块食管切除术的所有患者进行了识别。患者随访包括采用经内镜和横断面成像研究的结构化监测方案。局部复发定义为吻合口处组织学证实的复发。区域复发定义为腹腔、纵隔或食管旁/导管淋巴结病的放射学证据。提取了人口统计学、病理学、治疗学变量以及无病生存率和总生存率。
在 755 例患者中，局部区域复发发生在 27 例（3.6%）患者中，其中 18 例被纳入分析。指数手术后无病生存中位数为 15 个月（IQR 10-23）。复发部位为局部（6/18，33.3%）；区域（8/18，44.4%）；和局部区域（4，22.2%）。最常见的治疗复发的方法是放化疗（10/18，55.6%），而 4 例（22.2%）行手术。局部区域复发治疗后 1 年总生存率为 61.1%，5 年总生存率为 22.2%。
整块食管切除术后局部区域复发的巩固性局部挽救治疗是可行的，并且可以使一部分患者获得长期生存。
