Trends in management and prognosis for esophageal cancer surgery: twenty-five years of experience at a single institution.
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.
Ruol
Alberto
A
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
Castoro
Carlo
C
Portale
Giuseppe
G
Cavallin
Francesco
F
Sileni
Vanna Chiarion
VC
Cagol
Matteo
M
Alfieri
Rita
R
Corti
Luigi
L
Boso
Caterina
C
Zaninotto
Giovanni
G
Peracchia
Alberto
A
Ancona
Ermanno
E
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