ANASTOMOTIC RECURRENCE OF ESOPHAGEAL SQUAMOUS-CELL CARCINOMA AFTER TRANSTHORACIC ESOPHAGECTOMY

Objective: To assess the incidence of anastomotic recurrence of oesoph ageal carcinoma and its relationship with proximal surgical margin inv aded by tumour. Design: Retrospective study. Setting: National Cancer Center, Tokyo. Subjects: 463 patients with thoracic oesophageal squamo us carcinoma who underwent transthoracic oesophagectomy with a minimal follow-up of three years. Main outcome measures: Proximal surgical ma rgin, anastomotic recurrence rate, prognosis. Results: Anastomotic rec urrence developed in 12 of the 463 patients (3%), 10 of whom had histo logically clear surgical margins. Sixteen patients had histologically invaded surgical margins, 13 of whom developed recurrent disease, 2 (1 3%) at the anastomosis; These 2 patients died of other diseases after treatment for their recurrent tumours. Two patients with anastomotic r ecurrence lived for over 5 years without signs of disease after excisi on of the recurrent tumour. Necropsy of 47 patients with recurrent tum ors showed that only one (2%) was at the anastomosis. Conclusions: Ana stomotic recurrence was not inevitable and was rarely fatal in patient s with invaded proximal surgical margins at transthoracic oesophagecto my. However, although infrequent, it did occur, even in patients with a cancer-free surgical margin. Resection may be indicated for patients with anastomotic recurrence and no other signs of metastases.