Patterns of recurrence of esophageal carcinoma after transhiatal esophagectomy and gastric interposition

Becker, CD; Pa, Barbier; Terrier, F; Porcellini, B.

doi:10.2214/ajr.148.2.273

Cited by 30 publications

(4 citation statements)

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“…The most likely explanation for the improved survival after transthoracic EBE in the present study is better removal of local-regional disease, that is, unrecog- nized microscopic disease was removed when using en bloc lymph node dissection but was left behind when using transhiatal lymph node dissection. In support of this explanation is the observation that transthoracic EBE, according to the literature, 3,9,[12][13][14][15][16][17][18] results in better control of local-regional disease (Table 5). Indeed, in clinical trials, [18][19][20][21][22][23][24] neoadjuvant radiochemotherapy has been added to THE in an effort to control local-regional disease, but without great success.…”

Section: Commentmentioning

confidence: 77%

En Bloc vs Transhiatal Esophagectomy for Stage T3 N1 Adenocarcinoma of the Distal Esophagus

et al. 2004

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Hypothesis: En bloc esophagectomy (EBE) provides improved survival over transhiatal esophagectomy (THE) in patients with similarly sized transmural tumors (T3) and lymph node metastases (N1).Design: A retrospective case-control study of 2 methods of esophageal resection for cancer.Setting: University hospital (tertiary referral center for esophageal disease).Patients: There were 49 patients (27 who underwent EBE and 22 who underwent THE) with similar T3 N1 disease and the following matched criteria: tumors of similar size and location, more than 20 lymph nodes in the surgical specimen, R0 resection, no previous chemotherapy or radiation therapy, and follow-up until death or for a minimum of 5 years.Main Outcome Measure: Survival adjusted for dif-ferences in demographic and patient characteristics.Results: The number of nodes harvested was greatest after EBE vs THE (median, 52 vs 29 [range, 21-85 vs 20-60]; PϽ.001). The median number of involved nodes was similar after EBE vs THE (median, 5 vs 7 [range, 1-19 vs 1-16]). The only 2 independent factors that affected survival in a Cox analysis were the number of involved lymph nodes (P = .01) and the type of resection (P = .03). Patients who underwent EBE had a survival benefit over those who underwent THE (P =.01). The survival benefit of EBE was seen only in patients with fewer than 9 involved lymph nodes (PϽ.001). Conclusion:En bloc esophagectomy confers a better survival than THE in patients with T3 N1 disease and fewer than 9 lymph node metastases.

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Section: Commentmentioning

confidence: 77%

En Bloc vs Transhiatal Esophagectomy for Stage T3 N1 Adenocarcinoma of the Distal Esophagus

et al. 2004

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“…7 The rate of recurrence of EC even after curative surgery was found to be high in most reports. [7][8][9][10] The available therapeutic modalities, such as radical resection, palliative resection and bypass, laser thermo coagulation, chemotherapy, and radiotherapy alone or in combination can be undertaken for recurrent cancer if there is an early diagnosis. In the detection of tumor recurrence, the selected imaging modalities are important in many regards.…”

Section: Discussionmentioning

confidence: 99%

Comparison of CT and MRI for the diagnosis recurrent esophageal carcinoma after operation

Kantarcı

Polat

Alper

et al. 2004

Diseases of the Esophagus

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Despite an increase in radical surgery for esophageal carcinoma, many patients continue to develop recurrent disease. Some reports have suggested that recurrent tumors should be treated aggressively with a combination of chemotherapy and radiotherapy. The aim of this study was to assess the comparative utility of computed tomography (CT) and magnetic resonance imaging (MRI) for the evaluation of recurrence after curative resection of cancer of the esophagus and gastroesophageal junction. To maximize survival benefit, detection of tumor recurrence as early and accurately as possible is important. Twenty-three patients who developed recurrent tumors after curative transthoracic esophagogastrectomy for esophageal carcinoma were analyzed retrospectively. The CT and MRI findings were correlated with pathology or with endoscopic and clinical follow-up. Primary tumor recurrence was detected at the anastomosis side in 19 patients (intraluminal mass in 13 and as diffuse or focal wall thickening in six). Distant recurrence was seen in the liver (n = 5), lung (n = 4), bone (n = 3), abdominal lymph node (n = 4), pleural effusion (n = 2) and pericardial effusion (n = 1). CT and MRI were found equal in showing the intraluminal mass, liver metastasis, pleural and pericardial effusion. Thickening of esophageal wall was demonstrated in nine patients using CT, but only seven of these tumor recurrences were confirmed by MRI, the remaining two were related to secondary fibrosis. Both CT and MRI showed diffuse gastric wall thickening determined as false tumor recurrence due to severe gastritis in one case. There were two (50%) false negatives for lung metastasis in MRI and one bone metastasis (33%) false negative in CT. CT was found superior in the demonstration of lung metastasis and MRI was superior in the evaluation of wall thickening and bone metastasis.

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“…Reported 5-year survival rates in patients with resected stage I esophageal cancer range from 50% to 80% (48 -51), which are far better than those in patients with more advanced disease. The reported overall 5-year survival rates vary from 5% to 35% (52)(53)(54)(55)(56), and the recurrence rates after curative surgery range between 34% and 79% (50,56 -59).…”

Section: Recurrencementioning

confidence: 99%

Postoperative Imaging of Esophageal Cancer: What Chest Radiologists Need to Know

Kim¹,

Lee²,

Kim³

et al. 2007

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Patterns of recurrence of esophageal carcinoma after transhiatal esophagectomy and gastric interposition

Cited by 30 publications

References 5 publications

En Bloc vs Transhiatal Esophagectomy for Stage T3 N1 Adenocarcinoma of the Distal Esophagus

En Bloc vs Transhiatal Esophagectomy for Stage T3 N1 Adenocarcinoma of the Distal Esophagus

Comparison of CT and MRI for the diagnosis recurrent esophageal carcinoma after operation

Postoperative Imaging of Esophageal Cancer: What Chest Radiologists Need to Know

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