Classification of recurrent esophageal cancer after radical esophagectomy with two- or three-field lymphadenectomy

Background: Although patients with recurrent diseases have a very poor prognosis, appropriate pretreatment classification for management of recurrent esophageal cancers has yet to be identified. The patterns of recurrence following radial esophagectomy were retrospectively assessed, and evaluated for possible adaptation as a novel classification of recurrent esophageal cancer. Patients and Methods: One hundred and sixty thoracic esophageal cancer patients (142 men; 18 women), who underwent radical esophagectomy without preoperative treatment, were studied. Results: Recurrence occurred in 59 (36.8 %) patients. The relationship between recurrence and clinicopathological features revealed significant associations between recurrence and age at surgery (p < 0.05), tumor (p < 0.0001), lymph node (p < 0.0001) and metastatic status (p < 0.01), pathological stage (p < 0.0001) and lymph node dissection (p < 0.0001). Locoregional recurrence occurred in 13 (22 %) patients, distant in 30 (51 %) and mixed in 16 (27 %). Mixed recurrence occurred the fastest and showed the poorest prognosis. A novel classification for recurrent esophageal cancer was proposed based on the clinical findings. Univariate analysis of the prognostic factors for post-recurrent survival revealed a significant association with distant organ recurrence (p < 0.05). Conclusion: Mixed recurrence had a poorer outcome than other recurrences. The proposed classification of clinical findings for recurrent esophageal cancer was shown to be useful; however, further studies with a larger number of recurrent esophageal cancers are required for stage grouping of the proposed classification.