Anna Junttila1, Olli Helminen2, Mika Helmiö3, Heikki Huhta2, Raija Kallio4, Vesa Koivukangas2, Arto Kokkola5, Simo Laine3, Elina Lietzen3, Sanna Meriläinen2, Vesa-Matti Pohjanen6, Tuomo Rantanen7, Ari Ristimäki8,9, Jari V Räsänen10, Juha Saarnio2, Eero Sihvo11, Vesa Toikkanen12, Tuula Tyrväinen13, Antti Valtola7, Joonas H Kauppila2,14. 1. Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland. anna.junttila@fimnet.fi. 2. Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland. 3. Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland. 4. Department of Oncology and Radiotherapy, Oulu University Hospital, Oulu, Finland. 5. Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 6. Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland. 7. Department of Surgery, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland. 8. Department of Pathology, HUSLAB, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. 9. Applied Tumor Genomics Research Program, Research Programs Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland. 10. Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 11. Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland. 12. Department of Cardiothoracic Surgery, Heart Center, Tampere University Hospital and University of Tampere, Tampere, Finland. 13. Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland. 14. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Insitutet and Karolinska University Hospital, Stockholm, Sweden.
Abstract
BACKGROUND: No population-based studies comparing long-term survival after transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) exist. This study aimed to compare the 5-year survival of esophageal cancer patients undergoing THE or TTE in a population-based nationwide setting. METHODS: This study included all curatively intended THE and TTE for esophageal cancer in Finland during 1987-2016, with follow-up evaluation until 31 December 2019. Cox proportional hazard models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of 5-year and 90-day mortality. The results were adjusted for age, sex, year of operation, comorbidities, histology, neoadjuvant treatment, and pathologic stage. RESULTS: A total of 1338 patients underwent THE (n = 323) or TTE (n = 1015). The observed 5-year survival rate was 39.3% after THE and 45.0% after TTE (p = 0.072). In adjusted model 1, THE was not associated with greater 5-year mortality (HR 0.99; 95% CI 0.82-1.20) than TTE. In adjusted model 2, including T stage instead of pathologic stage, the 5-year mortality hazard rates after THE (HR 0.87, 95% CI 0.72-1.05) and TTE were comparable. The 90-day mortality rate for THE was higher than for TTE (adjusted HR 0.72; 95% CI 0.45-1.14). In subgroup analyses, no differences between THE and TTE were observed in Siewert II gastroesophageal junction cancers, esophageal cancers, or pN0 tumors, nor in the comparison of THE and TTE with two-field lymphadenectomy. The sensitivity analysis, including patients with missing patient records, who underwent surgery during 1996-2016 mirrored the main analysis. CONCLUSIONS: This Finnish population-based nationwide study suggests no difference in 5-year or 90-day mortality after THE and TTE for esophageal cancer.
BACKGROUND: No population-based studies comparing long-term survival after transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) exist. This study aimed to compare the 5-year survival of esophageal cancer patients undergoing THE or TTE in a population-based nationwide setting. METHODS: This study included all curatively intended THE and TTE for esophageal cancer in Finland during 1987-2016, with follow-up evaluation until 31 December 2019. Cox proportional hazard models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of 5-year and 90-day mortality. The results were adjusted for age, sex, year of operation, comorbidities, histology, neoadjuvant treatment, and pathologic stage. RESULTS: A total of 1338 patients underwent THE (n = 323) or TTE (n = 1015). The observed 5-year survival rate was 39.3% after THE and 45.0% after TTE (p = 0.072). In adjusted model 1, THE was not associated with greater 5-year mortality (HR 0.99; 95% CI 0.82-1.20) than TTE. In adjusted model 2, including T stage instead of pathologic stage, the 5-year mortality hazard rates after THE (HR 0.87, 95% CI 0.72-1.05) and TTE were comparable. The 90-day mortality rate for THE was higher than for TTE (adjusted HR 0.72; 95% CI 0.45-1.14). In subgroup analyses, no differences between THE and TTE were observed in Siewert II gastroesophageal junction cancers, esophageal cancers, or pN0 tumors, nor in the comparison of THE and TTE with two-field lymphadenectomy. The sensitivity analysis, including patients with missing patient records, who underwent surgery during 1996-2016 mirrored the main analysis. CONCLUSIONS: This Finnish population-based nationwide study suggests no difference in 5-year or 90-day mortality after THE and TTE for esophageal cancer.
Authors: Marianne C Kalff; Eivind Gottlieb-Vedi; Rob H A Verhoeven; Hanneke W M van Laarhoven; Jesper Lagergren; Suzanne S Gisbertz; Sheraz R Markar; Mark I van Berge Henegouwen Journal: Ann Surg Date: 2021-08-04 Impact factor: 12.969
Authors: Marianne C Kalff; Laura F C Fransen; Eline M de Groot; Suzanne S Gisbertz; Grard A P Nieuwenhuijzen; Jelle P Ruurda; Rob H A Verhoeven; Misha D P Luyer; Richard van Hillegersberg; Mark I van Berge Henegouwen Journal: Ann Surg Date: 2020-12-23 Impact factor: 13.787