title: Esophageal cancer with cirrhosis of the liver: results of esophagectomy in 18 consecutive patients.
abstract: BACKGROUND
  Patients with cirrhosis of the liver sometimes are candidates for esophagectomy with extensive lymphadenectomy.
  
  
  METHODS
  Of 271 patients with primary esophageal carcinoma, 19 patients (7.0%) had pathologically proven cirrhosis of the liver. Among those, 18 patients underwent esophagectomy with extensive lymph node dissection. Clinicopathologic characteristics of these 18 patients were retrospectively investigated.
  
  
  RESULTS
  Pathological T stages were pT1 in 3 patients, pT2 in 9 patients, pT3 in 2 patients, and pT4 in 4 patients. Hepatitis C virus antibody was positive in 1 patient, and 14 patients were alcoholics. Three patients had cryptogenic cirrhosis. Seven patients were classified as Child-Turcotte B and 11 were Child-Turcotte A. Three patients had ICG-R 15 over 30%. Fifteen patients (83.3%) developed a total of 35 postoperative complications. Three patients currently are alive without recurrence. Fifteen patients have died: 7 from cancer recurrence; 5 of causes unrelated to esophageal cancer; and 3 of operative death (operative mortality: 16.7% in 18 cirrhotic patients vs. 5.7% in 227 non-cirrhotic patients; P = .102). The 1- and 3-year survival rates for 18 resected cirrhotic patients were 50% and 21%, respectively, and those for 227 resected non-cirrhotic patients were 67% and 42%, respectively (P = .051). When operative deaths were excluded from the analysis, the 1- and 3-year survival rates for 15 cirrhotic patients were 60% and 25%, respectively, whereas those for 214 non-cirrhotic patients were 68% and 43%, respectively (P = .271).
  
  
  CONCLUSIONS
  Although cirrhosis has a high morbidity and mortality rate, Child-Turcotte A and B cirrhosis may not contraindicate curative esophagectomy for esophageal carcinoma. However, these patients need meticulous perioperative care to avoid postoperative complications.
authors: Second Department of Surgery, Shimane Medical University, Izumo, Japan. nigeka35@shimane-med.ac.jp
authors: M
authors: M
authors: Tachibana
authors: T
authors: T
authors: Kotoh
authors: S
authors: S
authors: Kinugasa
authors: D K
authors: DK
authors: Dhar
authors: M
authors: M
authors: Shibakita
authors: S
authors: S
authors: Ohno
authors: R
authors: R
authors: Masunaga
authors: H
authors: H
authors: Kubota
authors: H
authors: H
authors: Kohno
authors: N
authors: N
authors: Nagasue
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000150:complications* / Q000601:surgery*; D016629:Esophagectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis