Pattern of recurrence after extended esophagectomy for squamous cell carcinoma of the esophagus.
OBJECTIVE
To further investigate the underlying mechanism of the systemic spread of esophageal squamous cell carcinoma.


METHODS
Out of 151 patients who underwent a curative esophageal resection, 41 (27.1%) developed recurrent esophageal cancer. Nine recurrences (22%) were distant-hematogenous, 17 (41.5%) non-hematogenous, and 15 (36.5%) mixed. Hematogenous deposits accompanied 58.5% of the recurrences. The relation between several clinicopathological factors and the pattern of recurrence was evaluated.


RESULTS
Univariate analysis recognized the lack of adjuvant chemoradiation, the tumor location in the lower esophagus and the tumor dedifferentiation as promoting factors for hematogenous recurrence. Poorly differentiated or undifferentiated tumors presented a significantly higher microvessel density than moderately or well differentiated tumors. Tumor differentiation and tumor lower localization were independent predictors of hematogenous recurrence.


CONCLUSIONS
Patients with poorly differentiated or undifferentiated tumors, which are located at the lower esophagus and present high microvessel density, should be considered at high risk for hematogenous recurrences after extended esophagectomy.
Kyriazanos
Ioannis D
ID
Second Department of Surgery, Shimane Medical University, Izumo, Japan.
Tachibana
Mitsuo
M
Shibakita
Muneaki
M
Yoshimura
Hiroshi
H
Kinugasa
Shoichi
S
Dhar
Dipok K
DK
Nakamoto
Takeru
T
Fujii
Toshiyuki
T
Nagasue
Naofumi
N
D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D009367:Neoplasm Staging; D018919:Neovascularization, Physiologic / Q000502:physiology*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome