title: Trends in management and prognosis for esophageal cancer surgery: twenty-five years of experience at a single institution.
abstract: OBJECTIVE
  To investigate trends in results of esophagectomies to treat esophageal cancer at a single high-volume institution during the past 25 years.
  
  
  METHODS
  Retrospective cohort study in a university tertiary referral center.
  
  
  METHODS
  Patients with cancer of the thoracic esophagus or esophagogastric junction seen from 1980 through 2004 were included (N = 3493). Three time periods were defined: 1980-1987, 1988-1995, and 1996-2004.
  
  
  METHODS
  Clinical presentation, tumor characteristics, and morbidity, mortality, and survival rates among patients with esophageal cancer undergoing esophagectomy.
  
  
  RESULTS
  The ratio of squamous cell carcinoma to adenocarcinoma decreased from 3.3 to 1.7 (P <.001) during the study period, in parallel with an increase in the number of patients with tumors in the lower esophagus/esophagogastric junction. An increasing proportion of patients who underwent resection received neoadjuvant treatment (chemotherapy/chemoradiotherapy), and 1978 patients underwent esophagectomy. The R0 resection rate increased from 74.5% to 90.1% (P <.001). In addition, an increasing proportion of patients had early-stage tumor in the resected specimen. In-hospital postoperative mortality decreased from 8.2% to 2.6% (P <.001), and the 5-year survival rate significantly improved from 18.8% to 42.3% (P <.001) for all patients who underwent resection. Pathological tumor stage, completeness of the resection, time period, sex, tumor histological type, and tumor location influenced the prognosis of patients with esophageal cancer undergoing esophagectomy.
  
  
  CONCLUSIONS
  A change in location and histological type of esophageal cancer has occurred during the past 25 years. Earlier diagnosis, a multidisciplinary approach, and refinements in surgical technique and perioperative care have led to a significant reduction in postoperative mortality rate and improved long-term survival among patients with cancer of the thoracic esophagus or esophagogastric junction.
authors.affiliation: Department of Gastrointestinal and Surgical Sciences, Clinica Chirurgica III, University of Padova School of Medicine, Via Giustiniani 2, 35128 Padova, Italy. alberto.ruol@unipd.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Ruol
authors.forename: Carlo
authors.initials: C
authors.lastname: Castoro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Portale
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.forename: Vanna Chiarion
authors.initials: VC
authors.lastname: Sileni
authors.forename: Matteo
authors.initials: M
authors.lastname: Cagol
authors.forename: Rita
authors.initials: R
authors.lastname: Alfieri
authors.forename: Luigi
authors.initials: L
authors.lastname: Corti
authors.forename: Caterina
authors.initials: C
authors.lastname: Boso
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zaninotto
authors.forename: Alberto
authors.initials: A
authors.lastname: Peracchia
authors.forename: Ermanno
authors.initials: E
authors.lastname: Ancona
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D015331:Cohort Studies; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000401:mortality / Q000639:trends*; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies