Solitary Lymph Node Recurrence of Esophageal Squamous Cell Carcinoma : Surgical Failure or Systemic Disease ?

Background. Post-surgical solitary lymph node recurrence (SLNR) may be a characteristic of esophageal squamous cell carcinoma (ESCC). Methods. Among 402 patients who underwent curative resection for ESCC between 2003 and 2010, we retrospectively reviewed the cases of 148 patients who developed disease recurrence. Results. Among the 148 reviewed cases, 24 patients (16.2 %) developed SLNR and 124 (83.8 %) developed non-SLNR. Clinicopathological background did not differ between the two groups. Five-year overall survival was 37.8 % among the 22 patients with SLNR who received local treatment (surgery or radiation) with or without systemic chemotherapy, compared with only 2.5 % among patients with non-SLNR (p = 0.0002). Among the 24 cases of SLNR, 18 were localized inside the surgical field (i.e. the standard three-field regional lymph nodes), while six occurred outside of the surgical field (abdominal paraaortic nodes in four cases and mediastinum in two cases). Notably, of the six patients with SLNR outside of the surgical field, four survived without additional recurrence after SLNR development. Among patients with SLNR, survival was not associated with tumor location, tumor size, or time to recurrence. Initial tumor stage was not associated with SLNR incidence but was identified as a predictor of long-term survival among patients with SLNR. Conclusions. SLNR developed inside and outside of the surgical field, showing a relatively favorable prognosis with local treatment regardless of location. SLNR outside of the surgical field may actually be localized disease in ESCC. Esophageal cancer is among the most malignant gastrointestinal cancers. Even after radical resection, reported recurrence rates range from 43 to 53 %. Despite application of combined multimodality treatments, prognosis remains extremely poor for recurrent cases, with a median survival time of 3–10 months. Recurrence patterns include locoregional, hematogenous, dissemination, and lymph node (LN) recurrence, with LN recurrence being the most frequent, constituting 27–45 % of cases. No optimal treatment strategy has yet been established for esophageal cancer patients with LN recurrence. The majority of LN recurrences are accompanied by multiple or systemic disease, such that solitary lymph node recurrence (SLNR) is rare. Some studies show a relatively favorable prognosis among patients with SLNR who undergo locoregional therapy; however, only one prior study has analyzed clinicopathological parameters or prognosis in patients with SLNR, and it remains unknown whether SLNR is a localized or systemic disease. It is also important to identify prognostic factors that affect postrecurrence survival and to determine the effectiveness of SLNR treatment strategies. The present study aimed to investigate clinicopathological characteristics, clinical course, and long-term survival among patients who developed SLNR after curative esophagectomy for esophageal cancer, based on comparisons with patients showing other recurrence types. Electronic supplementary material The online version of this article (doi:10.1245/s10434-015-5086-y) contains supplementary material, which is available to authorized users. Society of Surgical Oncology 2016 First Received: 9 December 2015; Published Online: 13 January 2016 T. Makino, MD, PhD e-mail: tmakino@gesurg.med.osaka-u.ac. jp Ann Surg Oncol (2016) 23:2087–2093 DOI 10.1245/s10434-015-5086-y