Postesophagectomy morbidity, mortality, and length of hospital stay after preoperative chemoradiation therapy.
BACKGROUND
Data suggest that preoperative chemoradiation improves survival in patients with stage II and III esophageal tumors. Whether preoperative therapy increases postesophagectomy morbidity and mortality has not been determined. This study evaluates our postoperative results after chemoradiation therapy.


METHODS
From 1989 through 1998, 120 consecutive patients underwent chemoradiation therapy followed by esophagectomy at our institution. The medical records for these patients were reviewed to determine patient age, sex, race, cell type, operative technique, complications, deaths, and length of hospital stay (LOS).


RESULTS
There were 106 (88%) men and 14 (12%) women with a mean age of 58 (32 to 77) years. White patients predominated (114 of 120, 95%); 98 (82%) had adenocarcinoma and 22 (18%) had squamous cell carcinoma. Operative technique was transhiatal in 91 (76%) patients, three-incision in 23 (19%), Ivor-Lewis in 4 (3%), and thoracoabdominal in 2 (2%). There was 1 death. Complications developed in 44 (37%) patients; 59% (13 of 22) of squamous cell carcinoma patients and 32% (31 of 98) of adenocarcinoma patients developed complications. Respiratory complications occurred in 32% (7 of 22) of squamous cell carcinoma patients and in 3% (3 of 98) of adenocarcinoma patients. Mean length of stay after surgery was 15 days (range 7 to 163).


CONCLUSIONS
Postesophagectomy results after chemoradiation therapy are comparable to those reported after esophagectomy alone. Squamous cell carcinoma patients are nearly twice as likely to develop postoperative complications and are more likely to have respiratory complications than adenocarcinoma patients.
Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
John R
JR
Doty
Jorge D
JD
Salazar
Arlene A
AA
Forastiere
Elisabeth I
EI
Heath
Lawrence
L
Kleinberg
Richard F
RF
Heitmiller
D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D019583:Dose Fractionation, Radiation; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D016629:Esophagectomy / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant