A 15-year review of esophagectomy for carcinoma of the esophagus and cardia.
OBJECTIVE
To evaluate the effect of surgical approach and adjuvant therapy on patients with carcinoma of the esophagus and/or cardia.


METHODS
Retrospective analysis of 157 consecutive patients who underwent esophagectomy.


METHODS
A private university medical center and its affiliated community hospital.


METHODS
One hundred twenty men and 37 women (mean age, 61.7 years) with carcinoma of the esophagus and/or cardia that was surgically treated between 1978 and 1993.


METHODS
Three approaches were used for resection: Transhiatal esophagectomy (THE) (n = 67), transthoracic esophagectomy (TTE) (n = 71), and abdominal-only esophagectomy (AOE) (n = 19). Sixty-five patients received adjuvant radiotherapy and chemotherapy.


METHODS
Surgical mortality, morbidity, and survival and the effect of adjuvant therapy.


RESULTS
The overall surgical mortality rate was 7.6%: 12.7% with the TTE, 4.5% with the THE, and 0% with the AOE approach. A significantly increased incidence of adult respiratory distress syndrome (P < .001) and empyema (P < .001) was seen with the TTE approach. The average intraoperative blood loss (P = .08) and the median intensive care unit stay (P = .26) and hospital stay (P = .40) were decreased with the THE and AOE approaches when compared with the TTE approach without significance. The overall median survival time was 17 months, with a 5-year survival rate of 21%. There was no significant difference in survival by pathologic stage between approaches. The addition of adjuvant therapy did not affect the overall median survival time or the 5-year survival rate. Node-positive patients did benefit from adjuvant radiotherapy and chemotherapy, with increased median survival times from 7 to 15 months and a 5-year survival rate from 0% to 15% (P = .01).


CONCLUSIONS
The THE and AOE approaches have fewer early complications than does TTE. Both THE and TTE have equal long-term survival rates. Adjuvant therapy provides increased survival to node-positive patients with carcinoma of the esophagus and/or cardia.
Millikan
K W
KW
Department of General Surgery, Rush Medical College, Chicago, Ill., USA.
Silverstein
J
J
Hart
V
V
Blair
K
K
Bines
S
S
Roberts
J
J
Doolas
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia; D003131:Combined Modality Therapy; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome