title: Recurrence risk after Ivor Lewis oesophagectomy for cancer.
abstract: OBJECTIVE
  The aim of this study was to analyze the profile of tumor recurrence for patients operated on for cancer of oesophagogastric junction or oesophagus by Ivor-Lewis oesophagectomy.
  
  
  METHODS
  Patients undergoing potentially curative Ivor-Lewis oesophageal resection between January 1999 to December 2008 at a single center institution were retrospectively analyzed. Their clinical records, details of surgical procedure, postoperative course, pathological findings, recurrence and long term survival were reviewed retrospectively. Univariate and multivariate survival analyses were performed.
  
  
  RESULTS
  One hundred and twenty patients were analyzed. Fifty three patients (44%) presented recurrence during median follow-up of 58 months. Five-year relapse free survival (RFS) rate was 51% (95%CI = [46; 65%]). On multivariate analysis, pT stage > 2 (HR = 2.42, 95%CI = [1.22; 4.79] p = 0.011), positive lymph node status (HR = 3.69; 95% CI = [1.53; 8.96] p = 0.004) and lymph node ratio > 0.2 (HR = 2.57; 95%CI = [1.38; 4.76] p = 0.003) were associated with a poorer RFS and their combination was correlated to relapse risk. Moreover, preoperative tumor stenosis was associated with an increased risk of local recurrence (HR = 3.46; 95% CI = [1.38; 8.70] p = 0.008) whereas poor or undifferentiated tumor was associated with an increased risk of distant recurrence (HR = 3.32; 95% CI = [1.03; 10.04] p = 0.044).
  
  
  CONCLUSIONS
  pT stage > 2, positive lymph node status and lymph node ratio > 0.2 are independent prognostic factors of recurrence after Ivor-Lewis surgery for cancer. Their combination is correlated with an increasing risk of recurrence that may argue favorably, in addition with preoperative tumor stenosis assessment, for adjuvant treatment or reinforced follow-up.
authors.forename: Mael Chalret
authors.initials: MC
authors.lastname: du Rieu
authors.forename: Thomas
authors.initials: T
authors.lastname: Filleron
authors.forename: Benoit
authors.initials: B
authors.lastname: Beluchon
authors.forename: Marine
authors.initials: M
authors.lastname: Humeau
authors.forename: Charles-Henri
authors.initials: CH
authors.lastname: Julio
authors.forename: Eric
authors.initials: E
authors.lastname: Bloom
authors.forename: Laurent
authors.initials: L
authors.lastname: Ghouti
authors.forename: Sylvain
authors.initials: S
authors.lastname: Kirzin
authors.forename: Guillaume
authors.initials: G
authors.lastname: Portier
authors.forename: Bernard
authors.initials: B
authors.lastname: Pradère
authors.affiliation: Department of Digestive Surgery, Toulouse Purpan University Hospital, Toulouse III University, place du Dr Baylac, 31059 Toulouse France. carrere.n@chu-toulouse.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Carrère
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D012189:Retrospective Studies