Patterns of recurrence of esophageal carcinoma after transhiatal esophagectomy and gastric interposition

Serial barium and CT studies were performed for follow-up of 35 patients who had undergone transhiatal esophagectomy with gastric interposition for esophageal carcinoma. The results were compared with the clinical and pathologic findings. Thirteen patients (37%) were clinically and radiologically free of tumor recurrence after a mean observation period of 18 months. Twenty-one patients (60%) developed recurrent carcinoma within 12 months and one patient (3%) within 14 months. Thirteen patients were clinically asymptomatic when recurrence was detected radiologically. Recurrence was initially confined to the mediastinum in one-half of the patients, whereas the others already had distant metastases when recurrence first became evident. Because most of the recurrent lesions originated outside the interposed stomach, CT was more useful than barium studies in showing early recurrence. Radiologic follow-up including CT allows earlier detection of limited recurrent carcinoma after surgery and, thus, offers the possibility of appropriate additional palliative radiotherapy or chemotherapy.
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