Carcinoma esophagus is an aggressive malignancy with high recurrence rates even after curative resection. This study aimed to evaluate recurrence patterns—both locoregional and systemic—after curative esophagectomy and to identify clinical and pathological predictors of recurrence to guide post-treatment surveillance and therapeutic strategies.

This retrospective study of a prospectively maintained database included 314 patients with carcinoma esophagus who underwent curative esophagectomy at a tertiary oncology center in India between January 2012 and January 2020. Clinical, pathological, and treatment-related parameters were analyzed. Recurrence patterns and survival outcomes were evaluated. Statistical analysis was performed using SPSS version 29, with univariate and multivariate analyses to determine prognostic factors for recurrence.

The study included 314 patients, with a mean age of 54 years (range 22–82 years); the most common presenting symptom was dysphagia (92.0%), followed by anorexia (18.5%) and vomiting (10.5%). The overall recurrence rate was 30.9%, with systemic recurrence being the most common (12.1%), followed by locoregional (8.0%) and combined recurrences (10.8%). The liver (47%), lungs (34%), and mediastinal nodes (30%) were the most frequent sites of recurrence. Median survival post-recurrence was 9.13 months for locoregional, 7.53 months for systemic, and 5.2 months for combined recurrence. Univariate analysis revealed significant associations with smoking, alcohol use, tumor length, and lymphovascular invasion. Multivariate analysis identified poor response to neoadjuvant therapy, perineural invasion, and advanced disease stage as independent predictors of recurrence.

Recurrence after curative esophagectomy is driven by multiple factors, including tumor biology and treatment response. Identifying high-risk patients based on response to neoadjuvant therapy and pathological features can inform tailored surveillance and treatment approaches to improve patient outcomes.