Abstract: Objective To investigate the efficacy of reoperations for relapsed and recurrent carcinoma of the esophagus and the esophagogastric junction.
Methods The clinical data of 15 patients with relapsed and recurrent carcinoma of the esophagus and the esophagogastric junction who were surgically treated at the Fourth Hospital of Hebei Medical University from April 2002 to October 2012 were retrospectively analyzed. The mean duration between definite diagnosis and the first operation of the 12 patients with relapsed cancer was 28 months (range, 8 〖KG*9〗 66 months), and the mean duration between definite diagnosis and the first operation of the 3 patients with recurrent cancer was 196 months (range, 60 〖KG*9〗288 months). For patients with relapsed cancer at anastomosis, the esophagus was reconstructed with residual stomach if the residual stomach was big enough, or the esophagus was reconstructed with colon or jejunum if the residual stomach was not big enough or the patients needed to receive total gastrectomy. All the patients were followed up every half year via mail or phone call, and the follow up was ended till the death or December 31, 2012.Thoracoabdominal computed tomography (CT) and upper gastrointestinal imaging were carried out every half year within the first 2 years after operation and then once a year 2 years after the operation. Gastroscopy was applied to suspected patients. Pathological staging was done based on the condition of patients after the secondary operation. The survival rate was calculated by Kaplan Meier method, and the survival was analyzed using the Log rank test.
Results Of the 10 patients with relapsed cancer at anastomosis after gastroesophagectomy for carcinoma of the esophagogastric junction, 4 received resection of relapsed cancer+intrathoracic anastomosis of the residual stomach and esophagus, 4 received esophageal replacement with the colon, 2 received esophageal replacement with the jejunum. Of the 3 patients with recurrent squamous cell carcinoma (SCC) after resection of carcinoma of the esophagogastric junction, 2 received tumor resection+esophageal replacement with the colon, and 1 received resection of distal esophageal carcinoma and residual stomach+Roux en Y esophagojejunostomy. Two patients with relapsed cancer at the anastomosis after esophagectomy for SCC received relapsed cancer resection+cervical esophagogastrostomy. The mean operation time and intraoperative blood loss were 460 minutes (range, 390 〖KG*9〗540 minutes) and 430 ml (range, 200 〖KG*9〗700 ml). Postoperative acute respiratory distress syndrome, pulmonary infection and cervical incisional infection were observed in 3 patients, respectively. One patient died of myocardial　infarction and 1 died of pulmonary infection. The mean duration of hospital stay was 29.5 days( range, 25 〖KG*9〗36 days). There were 1 patient in stage Ⅰa, 1 in stage Ⅰb, 4 in stage Ⅱa, 4 in stage Ⅱb, 5 in stage Ⅲa. Of the 13 patients who were followed up, the median survival time of 6 in stage Ⅰ or Ⅱa was 25 months, and the median survival time of 7 patients in stage Ⅱb or Ⅲ was 16 months, with significant difference ( χ 2 =8.91, P <0.05).
Conclusions Reoperation for relapsed and recurrent carcinoma of esophagus and the esophagogastric junction is technically feasible, and it can improve the quality of life of patients, while it is a high risk operation, and the indication should be strictly controlled.