Author correspondence to: Dr Ahmad Kamaludin, National Oesophageal and Gastric Cancer Centre, St. James’s Hospital, Dublin 8 D08 NHY1, Ireland. E-mail: kamaluda@tcd.ie Specific author contributions: Concept and design: Claire L. Donohoe, Ahmad Kamaludin; Data collection: Ahmad Kamaludin, Matthew Kavanagh; Statistical analysis: Ahmad Kamaludin, Claire L. Donohoe, Noel E. Donlon; Interpretation of data: Ahmad Kamaludin, Claire L. Donohoe; Writing: Ahmad Kamaludin, Claire L. Donohoe; Review and revision of manuscript: Ahmad Kamaludin, Claire L. Donohoe, John V. Reynolds. Conflicts of interest: The authors declare that they have no conflict of interest. © The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Diseases of the Esophagus (2023), 36, 1–7 https://doi.org/10.1093/dote/doac064 Original Article Single-center experience in implementation of endoscopic surveillance protocol after esophagectomy Ahmad Kamaludin, 1,2 Noel E. Donlon, 1 Matthew Kavanagh, 1,2 John V. Reynolds, 1 Claire L. Donohoe 1 1 National Oesophageal and Gastric Cancer Centre, St. James’s Hospital, Dublin, Ireland, and 2 Dublin South East Intern Network, Trinity College Dublin, Dublin, Ireland SUMMARY.Esophageal cancer has a notably high recurrence rate with a paucity of robust evidence in defining the optimal surveillance strategy. The surveillance protocol at our institution comprises of annual esophagogas- troduodenoscopy (OGD) from years 1 to 5 postoperatively. This study aims to evaluate the implementation of the endoscopic surveillance at our center and ascertain the value of endoscopy in detecting local recurrence after esophagectomy. A retrospective cohort review of all patients (320 patients) who underwent esophagectomy between 2013 and 2018 was conducted. The local esophageal cancer database and corresponding OGD reports were accessed to obtain data on demographics, operation details, local recurrence, and endoscopy performed. 1086 OGDs were performed between 2014 and 2020, broadly categorized to surveillance and symptomatic OGDs; 555 and 531, respectively. Surveillance OGDs detected four asymptomatic local recurrences, of which only one was treated with curative intent. Symptomatic OGDs resulted in a higher yield for the detection of local recurrence compared with surveillance endoscopy; 5% versus 0.7%, with overall median time-to-recurrence of 11.5 months (95% confidence interval 9–17). Of local recurrences, 85.7% occurred within the first 2 years postoperatively. The proportion of endoscopic findings differed between intensive and ad hoc surveillance cohorts for strictures, esophagitis, Barrett’s esophagus, and sloughing. Thirteen patients were diagnosed with histologically confirmed Barrett’s with no subsequent local recurrences. Surveillance endoscopy had a low positive yield rate with subsequent minimal survival benefits. Therefore, it is prudent to consider an alternative protocol that focuses on the period with the highest risk of recurrence and symptom presentation. KEY WORDS: endoscopy, esophageal cancer surgery, surveillance. INTRODUCTION Esophageal cancer has a dismal prognosis and is asso- ciated with a low survival rate. 1 Advances in the man- agement of esophageal cancer that include the central- ization of esophageal surgery in high-volume centers 2 and introduction of novel neoadjuvant chemother- apy or chemoradiotherapy 3– 5 have reduced the over- all mortality and improved survival rates. The over- all 5-year survival rate in Ireland has doubled from 10% in the 1990s to 22% in recent years 1 with a reduction in postoperative mortality from 6.7% to 1.7%. 6 Despite these advances in curative treatment, esophageal cancer continues to recur at a notably high rate, up to 50% within 2–3 years of surgery. 7, 8 Imple- mentation of surveillance after definitive treatment is a salient component of oncological care to allow early detection of recurrences. However, there remains a paucity of evidence in the literature to support the implementation of a surveillance protocol, with mini- mal randomized controlled trials executed in the past to impart robust, high-quality evidence on the subject. A clear consensus on the optimal surveillance proto- col for esophageal cancer after esophagectomy is yet to be established. 9 – 11 The recent ENSURE multicenter cohort study exploring the impact of postesophagectomy surveil- lance on postoperative outcomes noted that intensive surveillance was associated with an improvement in oncological outcomes and overall survival in select cohorts, with computed tomography (CT) imaging as the modality of choice for intensive surveillance. 12 The NeoAEGIS (Neoadjuvant Trial in Adenocarcinoma of Esophagus and Esophagogastric Junction International Study), 13 an international multicenter randomized controlled trial spearheaded from our center, was the first trial designed to assess whether neoadjuvant multimodal therapy 1 Downloaded from https://academic.oup.com/dote/article/36/3/doac064/6705377 by guest on 07 June 2023