title: Pattern of recurrence after extended esophagectomy for squamous cell carcinoma of the esophagus.
abstract: 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.
authors.affiliation: Second Department of Surgery, Shimane Medical University, Izumo, Japan.
authors.forename: Ioannis D
authors.initials: ID
authors.lastname: Kyriazanos
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Tachibana
authors.forename: Muneaki
authors.initials: M
authors.lastname: Shibakita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshimura
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kinugasa
authors.forename: Dipok K
authors.initials: DK
authors.lastname: Dhar
authors.forename: Takeru
authors.initials: T
authors.lastname: Nakamoto
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Fujii
authors.forename: Naofumi
authors.initials: N
authors.lastname: Nagasue
mesh_terms: 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