ORIGINAL SCIENTIFIC REPORT
Locoregional Tumor Extension and Preoperative Smoking are
Signiﬁcant Risk Factors for Early Recurrence After
Esophagectomy for Cancer
Published online: 28 December 2017
Internationale de Chirurgie 2017
Background Tumor recurrence during the ﬁrst year after oncological esophagectomy has been reported in up to
17–66% of patients. However, little is known as to the risk factors potentially associated with this adverse outcome.
The aim of this retrospective observational study was to identify clinically relevant parameters associated with early
Methods All patients with squamous cell cancer or adenocarcinoma of the esophagus or gastroesophageal junction,
operated with curative intent in our center from 2000 to 2014, were screened for this study. Univariate analysis was
conducted to identify variables potentially associated with early recurrence, and clinically relevant parameters with
P \ 0.1 were included in multiple logistic regression. Survival analyses were conducted with the Kaplan–Meier
method. Signiﬁcance threshold was set at P \ 0.05.
Results Among the 164 included patients, 46 (28%) presented early recurrence. Eight patients (17.4%) had
locoregional and 38 patients (82.6%) metastatic recurrence. Advanced T and N stages, lymph node capsular
effraction, a high positive-to-resected lymph node ratio, positive resection margins, poor response to neoadjuvant
treatment, preoperative active smoking, malnutrition and dysphagia were associated with early recurrence on a
univariate level. In multivariable analysis, preoperative smoking (OR 2.76, 95% CI 1.28–6.17), pT stage (OR 1.72,
95% CI 1.18–2.58) and an increased positive-to-resected lymph node ratio (OR 6.72, 95% CI 1.08–48.51) remained
independently associated with ER.
Conclusion Our study identiﬁed both patient- and tumor-related parameters as risk factors for early recurrence after
oncological esophagectomy. Of particular interest, active smoking was signiﬁcantly associated with this adverse
outcome, highlighting the importance of preoperative smoking cessation.
Despite signiﬁcant progress in multidisciplinary treatment
of esophageal cancer during recent years, long-term out-
comes remain dismal. Up to 60% of patients are considered
inoperable upon diagnosis, and surgical resection will
eventually be carried out in only 10–15% of all patients .
Current 5-year survival of esophageal cancer patients
This article has been presented in parts in the 103th Congress of the
Swiss Society of Surgery (SSC-SGC), June 1–3, 2016, Lugano,
Switzerland, and the 27th Congress of the European Society of
Diseases of the Esophagus, Munich, December 1–3, 2016.
Electronic supplementary material The online version of this
article (https://doi.org/10.1007/s00268-017-4422-8) contains supple-
mentary material, which is available to authorized users.
& Markus Scha
Department of Visceral Surgery and Transplantation,
Lausanne University Hospital (CHUV), Rue du Bugnon 46,
1011 Lausanne, Switzerland
World J Surg (2018) 42:2209–2217