Autopsy findings in patients after curative esophagectomy for esophageal carcinoma.
BACKGROUND
The mode of recurrence after esophagectomy for esophageal cancer has seldom been studied in detail from autopsy findings.


METHODS
We reviewed the autopsy findings in 43 curatively resected cases of esophageal cancer between 1976 and 1997 at a single institution.


RESULTS
Recurrent or residual esophageal cancer was identified in 27 of the 43 patients (62.8%) at autopsy. Local recurrence, lymph node metastases, hematogenous metastases, and serosal carcinomatosis were observed in 11 (25.6%), 18 (41.9%), 17 (39.5%), and 11 patients (25.6%), respectively. Metastases to the thoracic, abdominal, and cervical nodes were observed in 37.2%, 16.3%, and 11.6% of the cases at autopsy, respectively. The pulmonary hilar nodes were most frequently involved (25.6%). The frequency of local recurrence was significantly lower in cases after curative subtotal esophagectomy with two- or three-field dissection (19.4%) than in cases after lower esophagectomy (66.7%) (p = 0.032). The frequency of hematogenous metastases after curative esophagectomy after preoperative radiotherapy was significantly lower in responders (Grades 2 to 3) than in nonresponders (Grades 0 to 1) (p = 0.035).


CONCLUSIONS
This study showed the characteristics of recurrence after esophagectomy for esophageal cancer. Despite esophagectomy with lymph node dissection, the frequency of each mode of recurrence was remarkably high. Anatomic difficulty of complete removal of lymph nodes by surgical procedures was suggested. Hematogenous metastases and serosal carcinomatosis were beyond surgical resection. More effective multimodal therapy will be required to improve survival of esophageal cancer patients.
Katayama
Atom
A
Department of Gastrointestinal Surgery, The University of Tokyo Graduate School of Medicine, Japan.
Mafune
Ken-ichi
K
Tanaka
Yoichi
Y
Takubo
Kaiyo
K
Makuuchi
Masatoshi
M
Kaminishi
Michio
M
D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001344:Autopsy; D002423:Cause of Death; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D009366:Neoplasm Seeding; D015995:Prevalence; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents