The distribution of recurrent lesions in the neck and mediastinum after radical surgery for cancer of the thoracic esophagus

To determine the location of cervical and/or mediastinal recurrence in cancer of the thoracic esophagus, computer tomographic scans of 40 patients presenting cervical or mediastinal recurrence after radical esophagectomy were retrospectively examined. The recurrent lesion was found only in a limited area on CT in 29 cases. The distribution of the recurrent lesions in patients who had undergone cervio-mediastinal en bloc dissection (group B) was different from that in the remaining cases (group A). Localized recurrence along the recurrent laryngeal nerves (RLNs) was quite frequent in group A (72%), though uncommon in group B. Recurrence along the thoracic decending aorta was most frequent in group B. Recurrence in the pretracheal region or anterior mediastinum was always associated with recurrence along the right RLN or in the tracheobronchial region. Localized recurrence in the deep cervical region or along the RLNs was quite common in shallow cancer not penetrating the esophageal muscle, while lower mediastinal recurrence was not found in such cancer. CT always demonstrated extensive mediastinal involvement in patients with lesions palpable in both sides of the neck, while the disease was occasionally localized in patients with an unilateral lesion, which were often satisfactorily treated with local therapy. The doubling time of the recurrent tumors ranged from one-half to six months (average 2.4 months) on CT in cases followed until the definite diagnosis. (author)