Factors predictive of complete resection of operable esophageal cancer: a prospective study.
BACKGROUND
Esophagectomy remains a standard treatment for patients with resectable esophageal cancer, but the 5-year survival is only 20% to 25%. After complete resection survival is significantly longer than after incomplete resection with microscopic or macroscopic penetration. The purpose of this study was to prospectively identify the factors predictive of complete resection of operable esophageal cancers.


METHODS
Betwen January 1995 and January 2002, 372 patients with esophageal cancer underwent surgery with curative intent. Complete resection was performed in 304 patients (81.7%), incomplete resection with microscopic penetration in 28 (7.5%), and incomplete resection with macroscopic penetration in 40 (10.8%). Univariate and multivariate analysis included 16 preoperative and operative factors.


RESULTS
Factors predictive of complete resection were absence of any modification of the esophageal axis on the barium swallow (p = 0.019) and a partial or complete response to preoperative radiochemotherapy (p = 0.042). Three groups of patients were identified: group 1 had no deviation of the axis on the barium swallow (n = 253); group 2 had deviation of the axis on the barium swallow and partial or complete response to radiochemotherapy (n = 66); and group 3 had deviation of the axis on the barium swallow and no response to radiochemotherapy or no preoperative treatment (n = 53). Rates of complete resection were 90.1%, 74.2%, and 50.9%, and 5-year actuarial survivals were 46%, 37%, and 0%, respectively (p < 0.001).


CONCLUSIONS
Complete resection of esophageal cancer is predictable. Deviation axis on the barium swallow and morphologic response to neoadjuvant radiochemotherapy are variables available for all patients at onset of therapeutic management.
Mariette
Christophe
C
Service de Chirurgie Digestive et Générale Hôpital Claude Huriez and Unité INSERM 560-CHRU, Lille, France.
Finzi
Laetitia
L
Fabre
Sylvain
S
Balon
Jean-Michel
JM
Van Seuningen
Isabelle
I
Triboulet
Jean-Pierre J
JP
D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D003287:Contrast Media; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy / Q000379:methods / Q000401:mortality; D009361:Neoplasm Invasiveness; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D015996:Survival Rate
D003287:Contrast Media; D001466:Barium Sulfate