title: [Surgical treatment of esophageal cancer : Evolution of management and prognosis over the last 3 decades].
abstract: BACKGROUND
  An increasing incidence of adenocarcinoma, a modified surgical strategy and the increasing use of multimodal therapeutic protocols have had a major impact on the surgical treatment of esophageal cancer during the last 3 decades.
  
  
  OBJECTIVE
  This study analyzed the development of these factors and their impact on the short and long-term prognosis of esophageal cancer over the last 25 years.
  
  
  METHODS
  The study included 366 patients with esophageal cancer treated by esophagectomy at the University Hospital in Freiburg from 1988 to 2012. The study period was split into four time periods for further comparisons, i.e. 1988-1994, 1995-2001, 2001-2006 and 2007-2012.
  
  
  RESULTS
  Within the time periods analyzed a marked increase in adenocarcinoma was found (time periods1988-1994, 1995-2001, 2001-2006 and 2007-2012: 21%, 37%, 61% and 64%, respectively, p<0.001). The initially commonly used transhiatal approach and reconstruction with cervical anastomosis was gradually replaced by the thoracoabdominal procedure with intrathoracic reconstruction (i.e. Ivor Lewis esophagectomy, 2007-2012: 98 %). During the study period increasingly more patients received multimodal therapy (13%, 85%, 72% and 84%, p<0.001), the overall rate of perioperative complications (70%, 88%, 73% and 56%, p<0.001) and perioperative mortality (16%, 18%, 8% and 2.5%, p<0.001) were significantly reduced, while the overall 5-year survival (12%, 34%, 41% and 62%, p<0.001) improved. An early tumor stage (p=0.002), N0 status (p<0.001) and histological type of adenocarcinoma (p=0.011) were identified as independent predictors of improved survival.
  
  
  CONCLUSIONS
  During the period from 1988 to 2012 a significant improvement of long-term survival as well as a marked reduction of perioperative mortality after esophagectomy were observed. The improved outcome was associated with an increased use of multimodal therapeutic protocols, the preferred use of thoracoabdominal esophagectomy and epidemiological changes in histology over the study period.
authors.affiliation: Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland, Torben.Glatz@Uniklinik-Freiburg.de.
authors.forename: T
authors.initials: T
authors.lastname: Glatz
authors.forename: G
authors.initials: G
authors.lastname: Marjanovic
authors.forename: K
authors.initials: K
authors.lastname: Zirlik
authors.forename: T
authors.initials: T
authors.lastname: Brunner
authors.forename: U T
authors.initials: UT
authors.lastname: Hopt
authors.forename: F
authors.initials: F
authors.lastname: Makowiec
authors.forename: J
authors.initials: J
authors.lastname: Hoeppner
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000639:trends; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant / Q000639:trends; D003131:Combined Modality Therapy / Q000639:trends; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000639:trends; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000639:trends; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013908:Thoracotomy / Q000639:trends