PD09.09. Post-Recurrence Survival After Esophagectomy for Esophageal Cancer: Impact of Timing and Anatomic Site

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Recurrent disease remains the leading cause of mortality following esophagectomy for esophageal carcinoma. While patterns of recurrence have been previously described, the prognostic impact of recurrence timing and site on post-recurrence survival (PRS) remains unclear. This study evaluated the impact of disease-free survival (DFS) duration and first recurrence site on PRS. A multicentric retrospective cohort study was conducted including patients who experienced recurrence following esophagectomy with curative intent for esophageal carcinoma between 2012-2023. The association between DFS and PRS was modeled continuously on Cox regression and linearity was assessed using Martingale residuals. Among 359 patients, 142 (39.6%) developed recurrence. Median follow-up was 40 months and median PRS was 12 months. On Kaplan–Meier analysis, PRS differed by DFS category (<6, 6–24, and >24 months; p=0.022), with the longest survival observed among patients recurring >24 months after surgery (18.2% of patients; median PRS 19 months) (Figure 1A). When modeled continuously in Cox regression, each 6-month delay in DFS was associated with an 11% reduction in post-recurrence mortality (HR per 6 months 0.89, p=0.011) (Figure 1B). Median PRS for isolated nodal recurrence (17.6% of patients) was 23 months and significantly longer than isolated local, isolated distant, or combined recurrences (p=0.003) (Figure 2). Isolated nodal recurrence was asymptomatic and detected at scheduled imaging in 22/25 (88%) patients. After adjustment for preoperative and pathologic variables, DFS >24 months and isolated nodal recurrence independently predicted longer PRS (HR 0.49, p=0.005 and HR 0.44, p=0.003, respectively). Among patients with recurrent esophageal carcinoma after esophagectomy, isolated nodal recurrence and DFS >24 months independently predicted prolonged PRS. These findings may help refine postoperative surveillance strategies and guide selection of patients most likely to benefit from salvage therapy.