A nation-wide survey of follow-up strategies for esophageal cancer patients after a curative esophagectomy or a complete response by definitive chemoradiotherapy in Japan

Background: There is a lack of critical evidence to justify the methods of follow-up after a curative esophagectomy or a complete response to definitive chemoradiotherapy (dCRT). Consequently, a wide variety of practices are in place throughout the world. Methods: A questionnaire concerning follow-up protocols was sent via electronic email for a nation-wide survey of the 117 Japanese hospitals that are recognized by the Japan Esophageal Society as training facilities for certified esophageal surgeons. Seventy-seven hospitals responded to the questionnaire. Results: Most hospitals follow their patients for at least 5 years after esophagectomy or dCRT, usually at a frequency of more than 4 times per year with clinical visits and physical examinations in the 1st and 2nd year after treatment. About 65–75 and 40 % of the hospitals continue the follow-up until the 7th and 10th year after treatment, respectively. Most hospitals measure CEA and SCC-Ag and almost all hospitals utilize CT scans of the cervix, chest and abdomen for the follow-up. Most of the hospitals reported performing an upper gastrointestinal endoscopy at least once per year until the 5th year after treatment, more frequently for post-dCRT patients than for post-esophagectomy patients. Other imaging modalities such as FDG-PET/CT, cervical and abdominal USs, and chest and abdominal X-rays were incorporated at much lower rates. Conclusions: Follow-up protocols for patients who have been treated for esophageal cancer with curative intent vary among the hospitals in Japan. Based on these data, the most popular follow-up protocols in Japan are shown.