Local recurrence after total or subtotal esophagectomy for esophageal cancer

Cancer recurrence is a common problem after esophagectomy for esophageal ca ncer. Local recurrence is especially problematic because it often negates t he palliative benefit of esophagectomy. We conducted a retrospective review to assess the effect of extent of esophageal resection (subtotal or total esophagectomy) on local cancer recurrence. Seventy-four consecutive patients with esophageal cancer underwent esophage ctomy at our institution over a four-year period. Their charts were reviewe d retrospectively and data was collected on age, gender, histology, stage, tumor location, operation, resection margin status, anastomotic leaks, oper ative mortality, adjuvant therapy, cancer survival, and local recurrence. Total esophagectomy was done in 19 patients (transhiatal - 3, McKeown - 16) and subtotal esophagectomy was done in the other 55 patients (Lewis - 25; left thoracoabdominal - 30). The two groups were similar with respect to ag e, gender, histology, stage, anastomotic leaks, operative mortality, adjuva nt therapy, and overall survival. Resection margins were positive for resid ual tumor in 2 out of 19 (11%) total esophagectomies and 9 out of 55 (16%) subtotal esophagectomies (p=0.42). Local recurrence occurred in 3 of 19 (16 %) patients treated with total esophagectomy and 23 out of 55 (42%) patient s treated with subtotal esophagectomy (p=0.04). We conclude that total esop hagectomy is associated with fewer local cancer recurrences than subtotal e sophagectomy. We, therefore, recommend total esophagectomy for the surgical treatment of esophageal cancer.