Impact of structured surveillance of patients with esophageal cancer following surgical resection with curative intent.

Background: Esophageal cancer (EC) is a disease with a poor prognosis. While treatment options have been improved, there is no consensus for surveillance strategies following therapy with curative intent. As the incidence of EC is rising and a large fraction of patients will experience disease recurrence, the need for evidence-based treatment and optimal surveillance is evident.

Study design: Included were 1128 patients with esophageal and gastroesophageal junction cancer (squamous cell/adenocarcinoma) that underwent surgical resection at the University Hospital Cologne (UHC) between 2012 and 2021. Patients were retrospectively split into two groups: monitored structured surveillance at the center (n = 635) (MSS) and not monitored surveillance (n = 493) (NMS).

Results: In the MSS group, we identified 292 (45.98 %) cases of recurrence while 66 (13.39 %) cases of recurrence were identified in the NMS group. Overall survival (OS) was not significantly longer in MSS than in NMS, yet a positive trend can be seen (p = 0.108). Progression free survival (PFS) was significantly different between groups (p ≤ 0.05). Almost a third of recurrences diagnosed in MSS were limited to a singular location. About 35 % of recurrences in MSS were treated or were intended to be treated with local treatment options like surgery or curative intended radiotherapy, by times in combination with sensitizing chemotherapy. The correlation of time of recurrence and time of death was stronger within NMS than in MSS.

Conclusions: Structured surveillance leads to detection of more patients with singular recurrence but no clear sign of prolonged survival. Further prospective trials are warranted to define the clinical benefit of structured surveillance.