Risk Factors for Local Recurrence and Optimal Length of Esophagectomy in Esophageal Squamous Cell Carcinoma.
BACKGROUND
The risk factors for local recurrence in residual esophagus after esophagectomy have not been well documented. This study aimed to identify risk factors of local recurrence and optimal length of esophageal resection in esophageal cancer.


METHODS
Patients who underwent curative esophagectomy with more than 2 years of follow-up were included. Patients who received preoperative chemoradiation or in whom the ex vivo length of proximal margin (LPM) from resected tumor was not documented in the pathologic report were excluded. A total of 551 patients from January 1995 to February 2013 were included.


RESULTS
Complete resection was possible in 516 patients (94%), and mean LPM was 3.4 ± 2.5 cm. Sex, age, location of tumor, location of anastomosis, minimally invasive esophagectomy, three-field lymphadenectomy, cell type, differentiation, proximal resection margin status, tumor size, number of dissected lymph nodes, and T stages were not risk factors for local recurrence in multivariate analysis. The N stage (p = 0.034) and LPM (p = 0.007) were risk factors for local recurrence in multivariate analysis. The LPM was not related to local recurrence in N0, but 5-year freedom from local recurrence was higher for LPM of 5 cm or greater in N+ esophageal cancer (72% in LPM less than 5 cm versus 93% in LPM of 5 cm or greater, p = 0.040).


CONCLUSIONS
Local recurrence after esophagectomy in esophageal cancer is related to lymphatic metastasis rather than to proximal margin status, which raises the possibility that the main mechanism of local recurrence is submucosal lymphatic metastasis. Esophagectomy with LPM more than 5 cm is recommended for esophageal cancer with nodal metastasis.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: chkang@snu.ac.kr.
Chang Hyun
CH
Kang
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Yoohwa
Y
Hwang
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Hyun Joo
HJ
Lee
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
In Kyu
IK
Park
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
Young Tae
YT
Kim
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis