OBJECTIVE: To assess the incidence of anastomotic recurrence of oesophageal carcinoma and its relationship with proximal surgical margin invaded by tumour. DESIGN: Retrospective study. SETTING: National Cancer Center, Tokyo. SUBJECTS: 463 patients with thoracic oesophageal squamous carcinoma who underwent transthoracic oesophagectomy with a minimal follow-up of three years. MAIN OUTCOME MEASURES: Proximal surgical margin, anastomotic recurrence rate, prognosis. RESULTS: Anastomotic recurrence developed in 12 of the 463 patients (3%), 10 of whom had histologically clear surgical margins. Sixteen patients had histologically invaded surgical margins, 13 of whom developed recurrent disease, 2 (13%) at the anastomosis. These 2 patients died of other diseases after treatment for their recurrent tumours. Two patients with anastomotic recurrence lived for over 5 years without signs of disease after excision of the recurrent tumour. Necropsy of 47 patients with recurrent tumors showed that only one (2%) was at the anastomosis. CONCLUSIONS: Anastomotic recurrence was not inevitable and was rarely fatal in patients with invaded proximal surgical margins at transthoracic oesophagectomy. However, although infrequent, it did occur, even in patients with a cancer-free surgical margin. Resection may be indicated for patients with anastomotic recurrence and no other signs of metastases.
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Kato et al. (2002) studied this question.