[Influence of neoadjuvant treatment on morbidity-mortality of esophagectomies].
BACKGROUND
To evaluate the influence of neoadjuvant treatment (chemotherapy and/or radiotherapy) on postoperative complications and hospital lethality in patients with esophageal cancer submitted to esophagectomy with two-field lymphadenectomy.


METHODS
Retrospective study of 132 patients with esophageal cancer admitted in Department of Surgery in Erasto Gaertner Hospital, from January 1987 to January 1998, divided according to realization of neoadjuvant treatment or not. Variables related to patient (sex, age, general condition, ponderal loss, co-morbidities, tabagism), to tumor (histological type, localization, staging) and to surgical procedure (type and localization of anastomosis, surgical time, hospitalization time) were noted and related to postoperative complications and mortality.


RESULTS
Ninety-nine patients (71.2%) were of male sex. The predominant histological type was squamous cell carcinoma in 94.7% of the cases. Eighty-eight patients (66.6%) were smokers, and the main co-morbidities noted were: chronic obstructive pulmonary disease (29.55%) and arterial hypertension (15.15%). The main localization of the tumor was inferior thoracic segment (56.06%), with average tumoral extension of 47,72 (8-70) mm. Six patients (4.54%) were stage I, 44 (33.33%) IIA, 24 (18.18%) IIB, 38 (28.80%) III and 17 (12.90%) IV. Considering the neoadjuvant treatment, 39 patients (29.54%) were submitted to chemotherapy and 22 (16.67%) to radiotherapy. The postoperative complications were 74.35% (p=0.0002) and 72.73% (p=0.0037), respectively. The complication rate was 39.3% and hospital lethality 13.70%, represented more frequently by pleuropulmonar causes.


CONCLUSIONS
Neoadjuvant chemotherapic and radiotherapeutic treatments were related to superior occurrence of postoperative complications, without influence on hospital lethality.
Tomasich
Flávio Daniel Saavedra
FD
Departamento de Cirurgia do Hospital Erasto Gaertner da Liga Paranaense de Combate ao Câncer, Curitiba, PR, Brasil.
Valladares
Gerardo Cristino Gavarrette
GC
Demarchi
Viviane Coimbra Augusto
VC
Gagliardi
Danilo
D
D000368:Aged; D001938:Brazil / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000401:mortality / Q000628:therapy*; D016629:Esophagectomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009017:Morbidity; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis