J R Siewert1, H J Stein, M Feith, B L Bruecher, H Bartels, U Fink. 1. Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany. siewert@nt1.chir.med.tu-muenchen.de
Abstract
OBJECTIVE: To analyze the changing pattern in tumor type and postoperative deaths at a national referral center for esophageal cancer in the Western world and to assess prognostic factors for long-term survival after resection. SUMMARY BACKGROUND DATA: During the past two decades, the epidemiology and treatment strategies of esophageal cancer have changed markedly in the Western world. The influence of these factors on postoperative deaths and long-term prognosis has not been adequately evaluated. METHODS: Between 1982 and 2000, 1,059 patients with primary esophageal squamous cell cancer or adenocarcinoma had resection with curative intention at a single center. Patient and tumor characteristics and details of the surgical procedure and outcome were documented during this period. Follow-up was available for 95.8% of the patients. Changing patterns in tumor type and postoperative deaths were analyzed. Prognostic factors for long-term survival were assessed by multivariate analysis. RESULTS: The prevalence of adenocarcinoma in patients with resected esophageal cancer increased markedly during the study period. The postoperative death rate decreased from about 10% before 1990 to less than 2% since 1994, coinciding with the introduction of a procedure-specific composite risk score and exclusion of high-risk patients from surgical resection. In addition to the well-established prognostic parameters, tumor cell type "adenocarcinoma" was identified as a favorable independent predictor of long-term survival after resection. The independent prognostic effect of tumor cell type persisted in the subgroups of patients with primary resection and patients with primary resection and R0 category. CONCLUSION: Esophagectomy for esophageal cancer has become a safe procedure in experienced hands. Esophageal adenocarcinoma has a better long-term prognosis after resection than squamous cell carcinoma.
OBJECTIVE: To analyze the changing pattern in tumor type and postoperative deaths at a national referral center for esophageal cancer in the Western world and to assess prognostic factors for long-term survival after resection. SUMMARY BACKGROUND DATA: During the past two decades, the epidemiology and treatment strategies of esophageal cancer have changed markedly in the Western world. The influence of these factors on postoperative deaths and long-term prognosis has not been adequately evaluated. METHODS: Between 1982 and 2000, 1,059 patients with primary esophageal squamous cell cancer or adenocarcinoma had resection with curative intention at a single center. Patient and tumor characteristics and details of the surgical procedure and outcome were documented during this period. Follow-up was available for 95.8% of the patients. Changing patterns in tumor type and postoperative deaths were analyzed. Prognostic factors for long-term survival were assessed by multivariate analysis. RESULTS: The prevalence of adenocarcinoma in patients with resected esophageal cancer increased markedly during the study period. The postoperative death rate decreased from about 10% before 1990 to less than 2% since 1994, coinciding with the introduction of a procedure-specific composite risk score and exclusion of high-risk patients from surgical resection. In addition to the well-established prognostic parameters, tumor cell type "adenocarcinoma" was identified as a favorable independent predictor of long-term survival after resection. The independent prognostic effect of tumor cell type persisted in the subgroups of patients with primary resection and patients with primary resection and R0 category. CONCLUSION: Esophagectomy for esophageal cancer has become a safe procedure in experienced hands. Esophageal adenocarcinoma has a better long-term prognosis after resection than squamous cell carcinoma.
Authors: S G Swisher; L Deford; K W Merriman; G L Walsh; R Smythe; A Vaporicyan; J A Ajani; T Brown; R Komaki; J A Roth; J B Putnam Journal: J Thorac Cardiovasc Surg Date: 2000-06 Impact factor: 5.209
Authors: Zhaohui Jin; Marie Holubek; William R Sukov; Christopher A Sattler; Anne E Wiktor; Robert B Jenkins; Tsung-Teh Wu; Harry H Yoon Journal: Am J Clin Oncol Date: 2019-02 Impact factor: 2.339
Authors: Michael Stahl; Hansjochen Wilke; Martin Stuschke; Martin K Walz; Ulrich Fink; Michael Molls; J Rüdiger Siewert; Michael Schroeder; Hans-Bruno Makoski; Ulrich Schmidt; Siegfried Seeber; Udo Vanhoefer Journal: J Cancer Res Clin Oncol Date: 2004-10-05 Impact factor: 4.553