Risk Factors for Local Recurrence and Optimal Length of Esophagectomy in Esophageal Squamous Cell Carcinoma

Background. The risk factors for local recurrence in residual esophagus after esophagectomy have not been well documented. This study aimed to identify risk factors of local recurrence and optimal length of esophageal resection in esophageal cancer. Methods. Patients who underwent curative esophagectomy with more than 2 years of follow-up were included. Patients who received preoperative chemoradiation or in whom the ex vivo length of proximal margin (LPM) from resected tumor was not documented in the pathologic report were excluded. A total of 551 patients from January 1995 to February 2013 were included. Results. Complete resection was possible in 516 patients (94%), and mean LPM was 3.4 +/- 2.5 cm. Sex, age, location of tumor, location of anastomosis, minimally invasive esophagectomy, three-field lymphadenectomy, cell type, differentiation, proximal resection margin status, tumor size, number of dissected lymph nodes, and T stages were not risk factors for local recurrence in multivariate analysis. The N stage (p = 0.034) and LPM (p = 0.007) were risk factors for local recurrence in multivariate analysis. The LPM was not related to local recurrence in N0, but 5-year freedom from local recurrence was higher for LPM of 5 cm or greater in ND esophageal cancer (72% in LPM less than 5 cm versus 93% in LPM of 5 cm or greater, p = 0.040). Conclusions. Local recurrence after esophagectomy in esophageal cancer is related to lymphatic metastasis rather than to proximal margin status, which raises the possibility that the main mechanism of local recurrence is submucosal lymphatic metastasis. Esophagectomy with LPM more than 5 cm is recommended for esophageal cancer with nodal metastasis. (C) 2016 by The Society of Thoracic Surgeons