Follow-up and recurrence after a curative esophagectomy for patients with esophageal cancer: The first indicators for recurrence and their prognostic values

Background: No standardized methods exist for the follow-up and treatment of recurrence after a curative esophagectomy for patients with thoracic esophageal cancers. Methods: One hundred seventy-five patients with thoracic esophageal cancer underwent a curative resection and were followed up during a median period of 3.0 years (3 months-18 years). The time to recurrence, the first indicators (FIs) to suspect recurrence, and the factors predictive of prognosis after recurrence were investigated. Results: Recurrence occurred in 72 (41.1%) of 175 patients. Forty (55.6%) and 22 (30.6%) of 72 cases presented with recurrences in the first and second year after the initial operation, respectively. Clinical visit (anamnesis and physical examination), tumor markers, and imaging were FIs in 39 (54.2%), 33 (45.8%), and 49 (68.1%) of 72 patients with recurrence, respectively. Imaging was the exclusive FI in 19 (26.4%) cases. A multivariate analysis showed the favorable prognostic factors after recurrence to be recurrence later than 1 year after the initial operation and a case in which the FI was only imaging. Conclusions: Intensive follow-up is required in the first 2 years after surgery, and early detection of recurrence is important. The accumulation of clinical data based on a fixed schedule with consensus is necessary to obtain more definite evidence for the diagnosis and treatment of recurrent esophageal cancer.