title: Annual computed tomography scans do not improve outcomes following esophagectomy for cancer: a 10-year UK experience.
abstract: Evidence for the best approach to follow-up patients after esophagectomy for cancer is scant and conflicting, and has led to a wide variety in practice. The aim of this study was to evaluate whether our annual routine computed tomography (aCT) scan program changes outcomes. A retrospective review of 169 patients who underwent esophagectomy for cancer in our unit between 2001 and 2010 was performed. aCT scan was part of follow-up in all patients to 5 years. Minimum follow-up was 37 months. The primary outcome measure was survival. Recurrence was detected in 61 cases (36%). aCT scan diagnosed recurrence in only a minority of cases (17 cases, 28%). In the majority of patients, clinical evidence prompted an unplanned CT scan (uCT; 44 cases, 72%). There was no difference in unadjusted survival between the two groups (hazard ratio = 0.61, 95% confidence interval 0.34-1.08, P = 0.090), nor was one more likely to receive secondary oncological treatment (aCT 41% vs. uCT 44%, P = 1.000). When we adjusted survival patterns for confounding covariates, the uCT cohort showed a protective effect (hazard ratio = 0.54, 95% confidence interval 0.28-0.98, P = 0.042). These data suggest that aCT scans do not influence management or survival after esophagectomy. A consensus follow-up protocol for patients treated for esophageal cancer remains to be established.
authors.affiliation: Upper GI Surgery, Department of Surgery, Mid-Essex Healthcare NHS Trust, Chelmsford, Essex, UK.
authors.forename: S S
authors.initials: SS
authors.lastname: Antonowicz
authors.forename: B
authors.initials: B
authors.lastname: Lorenzi
authors.forename: M
authors.initials: M
authors.lastname: Parker
authors.forename: C B
authors.initials: CB
authors.lastname: Tang
authors.forename: M
authors.initials: M
authors.lastname: Harvey
authors.forename: S S
authors.initials: SS
authors.lastname: Kadirkamanathan
mesh_terms: D000368:Aged; D016208:Databases, Factual; D055088:Early Detection of Cancer / Q000379:methods*; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D006113:United Kingdom
keywords: adenocarcinoma; esophageal cancer; esophagectomy; follow-up; survival