194. INTENSIVE SURVEILLANCE INCREASES SALVAGE SURGERY AND SURVIVAL RATES FOR ESOPHAGEAL CANCER

Background Following curative treatment there are no international follow-up guidelines, with most relying on symptoms for reinvestigation. This may delay diagnosis and impair survival. We hypothesized that intense surveillance would detect recurrent disease at a salvageable stage: and this study compared the outcome for patients undergoing salvage surgery for recurrent disease identified on intense surveillance with survival of patients that had undergone curative treatment for locoregionally advanced disease and didn’t require salvage surgery. Patients and Methods: A prospective database of esophageal carcinoma patients treated with curative intent was interrogated for patients with recurrent or new cancers amenable to salvage surgery. Surveillance consisted of 3-monthly endoscopy and 6-monthly CT scanning for 3 years, 6-monthly endoscopy and yearly CT scanning to 5 years, and endoscopy yearly with imaging as desired thereafter. Once new or recurrence cancer was diagnosed patients were restaged and, if suitable, underwent salvage surgery. Their outcome was compared with patients undergoing chemoradiotherapy plus or minus resection for locoregionally advanced disease. Results Of 205 patients treated with curative intent, 24 (11.7%) patients underwent salvage surgery for locoregional, metastatic or second primary tumours. They had a median survival of 48.4 months and a 3-year survival of 54.6%. This compares to 157 patients with locoregionally advanced disease not requiring salvage surgery, who had a median survival of 45.6 months and a 3-year survival of 44%, which was statistically insignificant between the groups (p = 0.975). Conclusions In this hypothesis-generating study an intensive surveillance strategy identified a cohort of patients (almost 12%) with recurrence disease or new primary cancers amenable to salvage surgery and with outcomes non-inferior to patients without recurrence. As most were asymptomatic, it is unlikely that curative intervention would have been as successful without surveillance. It is suggested that surveillance guidelines be updated to standardize interval endoscopy/imaging as for other GI malignancies.