Long-term outcome and risk of oesophageal cancer after surgery for achalasia.
BACKGROUND
Few studies have reported very long-term results after surgery for oesophageal achalasia. The aim of the present study was to assess long-term subjective outcomes after cardiomyotomy and partial fundoplication, focusing specifically on the risk of oesophageal cancer.


METHODS
Clinical and demographic information from 228 consecutive patients who had surgery between 1980 and 1992 was extracted from hospital files. Survival status and dates of death were obtained from census offices. Causes of death were obtained from public registries and compared with those of the general population. Symptoms were assessed by means of a questionnaire and endoscopy results were scrutinized.


RESULTS
Among 226 patients who could be traced, 182 of 184 survivors were contacted and the cause of death established for 41 of 42 patients. At a median follow-up of 18.3 years, almost 90 per cent of patients were satisfied with the treatment. Four had developed squamous cell oesophageal carcinoma 2, 8, 13 and 18 years after surgery, one of whom was still alive. The standardized mortality ratio for oesophageal carcinoma was significantly higher than expected in men.


CONCLUSIONS
Cardiomyotomy and partial fundoplication is an excellent long-term treatment for achalasia. Men with achalasia have an increased risk of developing oesophageal cancer.
Zaninotto
G
G
Department of General Surgery, S. Giovanni e Paolo Hospital, Venice, Padua, Italy. giovanni.zaninotto@unipd.it
Rizzetto
C
C
Zambon
P
P
Guzzinati
S
S
Finotti
E
E
Costantini
M
M
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004931:Esophageal Achalasia / Q000401:mortality / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000209:etiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors