title: Survival after esophageal resection for carcinoma: the importance of the histologic cell type.
abstract: BACKGROUND
  The significance of tumor cell type on survival after esophageal resection for carcinoma is uncertain. We reviewed our experience in order to compare the outcome in the two main histologic groups.
  
  
  METHODS
  Between January 1987 and April 2000, 621 patients underwent esophagectomy with curative intention for squamous cell carcinoma or adenocarcinoma. The postoperative outcomes of patients with adenocarcinoma and squamous cell carcinoma were compared.
  
  
  RESULTS
  Of the cohort, 424 patients had adenocarcinoma (group A) and 197 had squamous cell carcinoma (group B). The commonest approach in group A was a left thoracotomy (67%), while in group B, it was an Ivor Lewis resection (55%) (p < 0.0001). Operative mortality was 3.5% for group A and 8.1% for group B (p = 0.03). Cardiorespiratory complication rate was similar, but anastomotic leaks occurred more frequently in group B (4.2% vs 8.6%, p = 0.04). Patients in group B tended to have earlier pathologic tumor, node, metastasis (pTNM) stage (p = 0.06). Overall, survival was significantly better for group B (p = 0.003). Group B had a significantly better survival than group A in lymph node (LN) negative status (p = 0.01), and a relatively improved survival in LN positive status (p = 0.35). On multivariate analysis, squamous cell subtype (p = 0.034), pTNM stage (p = 0.005), LN status (p = 0.008), and completeness of resection (p = 0.028) were significant predictors of survival.
  
  
  CONCLUSIONS
  After esophagectomy, patients with squamous cell carcinoma have a poorer perioperative outcome as compared with those with adenocarcinoma. However, in the longer term, squamous cell type appears to confer a significant survival advantage.
authors.affiliation: Department of Cardiothoracic Surgery, Nottingham City Hospital, Nottingham, United Kingdom.
authors.forename: Christos
authors.initials: C
authors.lastname: Alexiou
authors.forename: Omar A
authors.initials: OA
authors.lastname: Khan
authors.forename: Edward
authors.initials: E
authors.lastname: Black
authors.forename: Mark L
authors.initials: ML
authors.lastname: Field
authors.forename: Patrick
authors.initials: P
authors.lastname: Onyeaka
authors.forename: Lynda
authors.initials: L
authors.lastname: Beggs
authors.forename: John P
authors.initials: JP
authors.lastname: Duffy
authors.forename: David F
authors.initials: DF
authors.lastname: Beggs
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002423:Cause of Death; D004564:Electrocoagulation; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality / Q000706:statistics & numerical data*; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D016019:Survival Analysis; D013908:Thoracotomy / Q000401:mortality