title: Survival after recurrent esophageal carcinoma has not improved over the past 18 years.
abstract: BACKGROUND
  Numerous patients will develop recurrent disease after esophagectomy for esophageal carcinoma (EC). In literature, survival after recurrent EC is poor with 6-8 months. In these studies, diagnostic imaging during follow-up (FU) is routinely performed. In the Netherlands, routine imaging is not part of FU and only performed on indication. The aim of this study was to determine survival after diagnosis of recurrent disease in patients after esophagectomy without routine imaging during FU.
  
  
  METHODS
  All EC patients who underwent esophagectomy between 1993 and 2010 were included and followed for clinical evidence of recurrent EC. Location, symptoms, diagnosis, and treatment of recurrent disease were registered. Pattern of recurrence was compared between patients who underwent neoadjuvant therapy and patients who underwent surgery alone. Survival after detection of recurrence was determined in all patients and related to the year of surgery.
  
  
  RESULTS
  A total of 493 of 1,088 patients (45 %) who underwent esophagectomy between 1993 and 2010 developed recurrent disease. Median interval between esophagectomy and recurrence was 10.5 months. Within the first 2 years after surgery, 33 % of patients developed recurrent EC. The majority of patients (51 %) were diagnosed with distant metastases. Locoregional recurrence occurred significantly less often among patients who underwent neoadjuvant therapy (6 vs 16 %, p = .017). Median survival after diagnosis of recurrent disease was 3 months. No relation was observed between the year of surgery and survival after recurrent disease (p = .931).
  
  
  CONCLUSIONS
  Survival after recurrent EC in patients who undergo FU without routine imaging after esophagectomy is approximately 3 months and has not improved over the past 18 years.
authors.affiliation: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Blom
authors.forename: Sjoerd M
authors.initials: SM
authors.lastname: Lagarde
authors.forename: Kim
authors.initials: K
authors.lastname: van Oudenaarde
authors.forename: Jean H G
authors.initials: JH
authors.lastname: Klinkenbijl
authors.forename: Maarten C
authors.initials: MC
authors.lastname: Hulshof
authors.forename: Hanneke W
authors.initials: HW
authors.lastname: van Laarhoven
authors.forename: Jacques J
authors.initials: JJ
authors.lastname: Bergman
authors.forename: Olivier R
authors.initials: OR
authors.lastname: Busch
authors.forename: Mark I
authors.initials: MI
authors.lastname: van Berge Henegouwen
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D002277:Carcinoma / Q000556:secondary / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy