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Risk Factors that Influence Early Death Due to Cancer Recurrence After Extended Radical Esophagectomy with Three-Field Lymph Node Dissection

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Extended radical esophagectomy with three-field lymph node dissection (3-FLD) has offered significant survival benefit, but some patients still suffer from early recurrence and die within 1 year after surgery. The purpose of this study was to identify the risk factors that influence early death due to cancer recurrence after extended radical esophagectomy with 3-FLD.

Methods

A consecutive series of 276 patients who underwent extended radical esophagectomy with 3-FLD was retrospectively reviewed. Excluding patients who underwent incomplete resection or died of other diseases within 1 year, we compared the clinicopathological characteristics between 203 patients who survived more than 1 year (1-year survival group) and 27 who died of cancer recurrence within 1 year (early-death group) by univariate and multivariate analysis.

Results

Sixty-six patients (32.5%) had recurrent disease in the 1-year survival group. Hematogenous recurrences were more frequent in the early-death group than in the 1-year survival group (41% vs. 26%, respectively, p = 0.0481). There was a significant difference in nodal status, number of metastatic nodes, pathological stage, vessel invasion, and intramural metastasis, and there was borderline significance in the difference of depth of invasion and histological type between the two groups by univariate analysis. Multivariate analysis demonstrated that intramural metastasis was an independent risk factor.

Conclusions

Patients with intramural metastasis have a significant risk of early death even after extended radical esophagectomy with 3-FLD; however, it remains unknown whether surgical intervention can play a significant role for these patients.

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References

  1. Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y. Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg. 1994;220:364–72.

    Article  PubMed  CAS  Google Scholar 

  2. Fujita H, Kakegawa T, Yamana H, et al. Mortality and morbidity rates, postoperative course, quality of life, and prognosis after extended radical lymphadenectomy for esophageal cancer. Comparison of three-field lymphadenectomy with two-field lymphadenectomy. Ann Surg. 1995;222:654–62.

    Article  PubMed  CAS  Google Scholar 

  3. Altorki N, Kent M, Ferrara C, Port J. Three-field lymph node dissection for squamous cell and adenocarcinoma of the esophagus. Ann Surg. 2002;236:177–83.

    Article  PubMed  Google Scholar 

  4. Sobin LH, Wittekind CH. TNM classification of malignant tumors, 6th edn. New York: Wiley-Liss; 2002.

    Google Scholar 

  5. Kosugi S, Sasamoto R, Kanda T, Matsuki A, Hatakeyama K. Retrospective review of surgery and definitive chemoradiotherapy in patients with squamous cell carcinoma of the thoracic esophagus aged 75 years or older. Jpn J Clin Oncol. 2009;39:360–6.

    Article  PubMed  Google Scholar 

  6. Nishimaki T, Suzuki T, Suzuki S, Kuwabara S, Hatakeyama K. Outcomes of extended radical esophagectomy for thoracic esophageal cancer. J Am Coll Surg. 1998;186:306–12.

    Article  PubMed  CAS  Google Scholar 

  7. National Cancer Institute. Common Terminology Criteria for Adverse Events v3.0. http://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/ctcaev3.pdf. Accessed 7 July 2010.

  8. Japan Esophageal Society. Japanese classification of esophageal cancer, 10th edn. Tokyo: Kanehara; 2008.

  9. Igaki H, Kato H, Tachimori Y, Sato H, Daiko H, Nakanishi Y. Prognostic evaluation for squamous cell carcinomas of the lower thoracic esophagus treated with three-field lymph node dissection. Eur J Cardiothorac Surg. 2001;19:887–93.

    Article  PubMed  CAS  Google Scholar 

  10. Nakagawa S, Kanda T, Kosugi S, Ohashi M, Suzuki T, Hatakeyama K. Recurrence pattern of squamous cell carcinoma of the thoracic esophagus after extended radical esophagectomy with three-field lymphadenectomy. J Am Coll Surg. 2004;198:205–11.

    Article  PubMed  Google Scholar 

  11. Kosugi S, Nishimaki T, Kanda T, Nakagawa S, Ohashi M, Hatakeyama K. Clinical significance of serum carcinoembryonic antigen, carbohydrate antigen 19-9, and squamous cell carcinoma antigen levels in esophageal cancer patients. World J Surg. 2004;28:680–5.

    Article  PubMed  Google Scholar 

  12. Lagarde SM, de Boer JD, ten Kate FJ, Busch OR, Obertop H, van Lanschot JJ. Postoperative complications after esophagectomy for adenocarcinoma of the esophagus are related to timing of death due to recurrence. Ann Surg. 2008; 247:71–6.

    Article  PubMed  Google Scholar 

  13. Watanabe M, Kuwano H, Araki K, et al. Prognostic factors in patients with submucosal carcinoma of the oesophagus. Br J Cancer. 2000;83:609–13.

    Article  PubMed  CAS  Google Scholar 

  14. Mal F, Perniceni T, Levard H, Denet C, Validire P, Gayet B. Pre-operative predictive factors of early recurrence after resection of adenocarcinoma of the esophagus and cardia. Gastroenterol Clin Biol. 2005;29:1275–8.

    Article  PubMed  Google Scholar 

  15. Takubo K, Sasajima K, Yamashita K, Tanaka Y, Fujita K. Prognostic significance of intramural metastasis in patients with esophageal carcinoma. Cancer. 1990;65:1816–9.

    Article  PubMed  CAS  Google Scholar 

  16. Nishimaki T, Suzuki T, Tanaka Y, Aizawa K, Hatakeyama K, Muto T. Intramural metastases from thoracic esophageal cancer: local indicators of advanced disease. World J Surg. 1996;20:32–7.

    Article  PubMed  CAS  Google Scholar 

  17. Hokamura N, Kato H, Tachimori Y, Watanabe H, Yamaguchi H, Nakanishi Y. Preoperative chemotherapy for esophageal carcinoma with intramural metastasis. J Surg Oncol. 2000;75:117–21.

    Article  PubMed  CAS  Google Scholar 

  18. Igaki H, Kato H, Ando N, et al. A randomized trial of postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus neoadjuvant chemotherapy for clinical stage II/III squamous cell carcinoma of the thoracic esophagus (JCOG 9907). ASCO Meeting Abstracts 26:4510.

  19. Kosugi S, Kanda T, Nakagawa S, Ohashi M, Nishimaki T, Hatakeyama K. Efficacy and toxicity of fluorouracil, doxorubicin, and cisplatin/nedaplatin treatment as neoadjuvant chemotherapy for advanced esophageal carcinoma. Scand J Gastroenterol. 2005;40:886–92.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Shin-ichi Kosugi MD, PhD.

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Kosugi, Si., Kanda, T., Yajima, K. et al. Risk Factors that Influence Early Death Due to Cancer Recurrence After Extended Radical Esophagectomy with Three-Field Lymph Node Dissection. Ann Surg Oncol 18, 2961–2967 (2011). https://doi.org/10.1245/s10434-011-1712-5

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  • DOI: https://doi.org/10.1245/s10434-011-1712-5

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