Annual computed tomography scans do not improve outcomes following esophagectomy for cancer: A 10-year UK experience

Abstract

Evidence for the best approach to follow-up patients after esophagectomy for cancer is scant and conflicting, and has led to a wide variety in practice. The aim of this study was to evaluate whether our annual routine computed tomography (aCT) scan program changes outcomes. A retrospective review of 169 patients who underwent esophagectomy for cancer in our unit between 2001 and 2010 was performed. aCT scan was part of follow-up in all patients to 5 years. Minimum follow-up was 37 months. The primary outcome measure was survival. Recurrence was detected in 61 cases (36%). aCT scan diagnosed recurrence in only a minority of cases (17 cases, 28%). In the majority of patients, clinical evidence prompted an unplanned CT scan (uCT; 44 cases, 72%). There was no difference in unadjusted survival between the two groups (hazard ratio=0.61, 95% confidence interval 0.34-1.08, P=0.090), nor was one more likely to receive secondary oncological treatment (aCT 41% vs. uCT 44%, P=1.000). When we adjusted survival patterns for confounding covariates, the uCT cohort showed a protective effect (hazard ratio=0.54, 95% confidence interval 0.28-0.98, P=0.042). These data suggest that aCT scans do not influence management or survival after esophagectomy. A consensus follow-up protocol for patients treated for esophageal cancer remains to be established.