title: Thoracoscopic-assisted esophagectomy for esophageal cancer: analysis of patterns and prognostic factors for recurrence.
abstract: OBJECTIVE
  The authors report the recurrence pattern of esophageal cancer after thoracoscopic-assisted esophagectomy (TAE), comparing it to the recurrence pattern after open surgery and identify prognostic factors for recurrence.
  
  
  BACKGROUND
  To improve long-term survival for esophageal cancer radical surgery has been proposed increasingly, however, recurrent disease remains a problem. Opinion is divided as to the adequacy of resection possible using minimally invasive techniques with concerns that there may be an increased incidence in locoregional recurrence.
  
  
  METHODS
  A total of 221 patients who underwent esophagectomy at the Princess Alexandra Hospital without any neoadjuvant or adjuvant therapy were identified from a prospective database. Patients were followed up for the detection of symptomatic recurrence for a median of 59 months.
  
  
  RESULTS
  Within this group 165 patients underwent TAE and 56 an open transthoracic esophagectomy (TTE). The 5-year overall recurrence rate was 133/221 (60%). The 5-year rates of symptomatic first recurrence following TAE was 4%, 9%, and 47% for local, regional, and distant recurrence, respectively. The 5-year rates of symptomatic first recurrence following TTE was 5%, 18%, and 55% for local, regional, and distant recurrence, respectively. Operative approach was not a prognostic factor for any type of recurrence. Independent prognostic factors associated with locoregional recurrence were positive margins and number of positive nodes. Distant recurrence was associated with T stage, differentiation, tumor length >6 cm, and number of positive nodes.
  
  
  CONCLUSIONS
  Distant recurrence remains a significant problem in esophageal cancer. TAE achieved adequate locoregional control and compared favorably with open TTE.
authors.affiliation: Upper Gastrointestinal and Soft Tissue Unit, The University of Queensland, Princess Alexandra Hospital, Queensland, Australia.
authors.forename: Iain G
authors.initials: IG
authors.lastname: Thomson
authors.forename: Bernard M
authors.initials: BM
authors.lastname: Smithers
authors.forename: David C
authors.initials: DC
authors.lastname: Gotley
authors.forename: Ian
authors.initials: I
authors.lastname: Martin
authors.forename: Janine M
authors.initials: JM
authors.lastname: Thomas
authors.forename: Peter
authors.initials: P
authors.lastname: O'Rourke
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Barbour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013906:Thoracoscopy