Prognostic factors and patterns of recurrence in esophageal cancer assert arguments for extended two-field transthoracic esophagectomy

Abstract Background High recurrence rates determine the dismal outcome in esophageal cancer. We reviewed our experiences and defined prognostic factors and patterns of recurrences after curatively intended transthoracic esophagectomy. Methods Between January 1991 and December 2005, 212 consecutive p...

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Bibliographic Details
Published in:The American journal of surgery 2010-10, Vol.200 (4), p.446-453
Main Authors: Smit, Justin K., M.Sc, Pultrum, Bareld B., M.D, van Dullemen, Hendrik M., M.D., Ph.D, Van Dam, Gooitzen M., M.D., Ph.D, Groen, Henk, M.D., Ph.D, Plukker, John T.M., M.D., Ph.D
Format: Article
Language:English
Subjects:
Abdomen
Aged
Aged, 80 and over
Biological and medical sciences
Biopsy
Biopsy, Fine-Needle
Cancer
Cancer therapies
Chemotherapy
Classification
Endosonography
Esophageal cancer
Esophageal Neoplasms - diagnosis
Esophageal Neoplasms - epidemiology
Esophageal Neoplasms - surgery
Esophagectomy - methods
Esophagus
Extended lymphadenectomy
Female
Follow-Up Studies
Gastroenterology. Liver. Pancreas. Abdomen
Gastrointestinal surgery
General aspects
Hospitals
Humans
Incidence
Lymph
Lymph Node Excision
Lymph nodes
Lymphatic Metastasis
Lymphatic system
Male
Medical prognosis
Medical sciences
Metastasis
Middle Aged
Neoplasm Recurrence, Local - diagnosis
Neoplasm Recurrence, Local - epidemiology
Neoplasm Recurrence, Local - prevention & control
Neoplasm Staging
Netherlands - epidemiology
Positron-Emission Tomography
Prognosis
Prognostic factors
Recurrence pattern
Retrospective Studies
Standard deviation
Stomach, duodenum, intestine, rectum, anus
Studies
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Survival
Survival Rate - trends
Time Factors
Tomography
Tomography, X-Ray Computed
Transthoracic esophagectomy
Tumors
Ultrasonic imaging
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Summary:Abstract Background High recurrence rates determine the dismal outcome in esophageal cancer. We reviewed our experiences and defined prognostic factors and patterns of recurrences after curatively intended transthoracic esophagectomy. Methods Between January 1991 and December 2005, 212 consecutive patients underwent a radical transthoracic esophagectomy with extended 2-field lymphadenectomy. Recurrence rates, survival, and prognostic factors were analyzed (minimal follow-up period, 2 y). Results Radicality was obtained in 85.6%. The median follow-up period was 26.6 months. The overall recurrence rate at 1, 3, and 5 years was 28%, 44%, and 64%, respectively, and locoregional recurrence rate was 17%, 27%, and 43%, respectively. Overall survival rates, including postoperative deaths, were 45% and 34% at 3 and 5 years, respectively. pT stage and lymph node (LN) ratio greater than .20 were independent prognostic factors for survival and recurrences. Radicality was most prognostic for survival, and for N+ greater than 4 positive LN for recurrences. Conclusions Radicality and LN ratio are strong prognostic factors. High radicality and adequate nodal assessment are guaranteed by an extended transthoracic approach.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2009.12.006