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Background: Evidence for the best approach to follow-up after oesophagectomy for cancer is scant and conflicting. Routine computer tomography scanning (CT) remains an integral part of oesophageal cancer follow up, despite recurrences often being signposted by symptoms and other mechanisms first. Additionally, there is wide variation in the frequency of CT scanning schedule owing to resource pressures and anecdotally perceived benefit.

Aims: We sought to determine how useful routine CT scanning was in detecting treatable stages of recurrence in an Upper Gastrointestinal cancer centre.

Methods: We performed a retrospective review of 126 consecutive patients who have undergone oesophagectomy between 2001 and 2009. Annual CT-scan was part of the routine follow-up in all patients. Two patients were lost to follow-up. Outcome data was focused on recurrence and mortality. Data was analysed using chi squared for binomial comparisons, the method of Kaplan-Meier for survival estimates, and the log-rank statistic to compare survival between cohorts.

Results: Recurrence was detected in 46 cases (37%). Median time to recurrence was 9 months (range 1-108 months). Median time to death from radiological confirmation of recurrence was 4 months (range 1-18 months), increasing to 13 months (range 6-18 months) if the patient subsequently underwent an interventional therapy (Χ2= 25.63, log-rank p<0.001). In nine cases, the recurrences were loco-regional; the remainder had a systemic component. In 12 cases CT detected recurrence in asymptomatic patients; in the remaining 34, suspicious symptoms or tumour marker rise prompted further investigation. Routine-detected recurrences were not more likely to have further interventional treatment for their cancer (Fisher, p=0.519), nor did it confer survival benefit (log-rank, p= 0.532). Subgroup analysis by neo-adjuvant therapy, preoperative stage and resection status further confirmed this.

Conclusion: Routine CT appeared to detect preclinical recurrences only in a handful of patients who had undergone oesophagectomy. The majority of recurrences were diagnosed when patients presented with symptoms. Our data suggests that routine CT scanning in asymptomatic patients may not add any survival benefit. A well-designed prospective study may give a definitive answer.