Histologic Tumor Type is an Independent Prognostic Parameter in Esophageal Cancer: Lessons from More Than 1,000 Consecutive Resections at a Single Center in the Western World

Overview

Journal Ann Surg

Specialty General Surgery

Date 2001 Aug 29

PMID 11524589

Citations 154

Authors

J R Siewert

H J Stein

M Feith

B L Bruecher

H Bartels

U Fink

Affiliations

Soon will be listed here.

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.

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References

Walsh T, Noonan N, Hollywood D, Kelly A, Keeling N, Hennessy T . A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996; 335(7):462-7. DOI: 10.1056/NEJM199608153350702. View

Whooley B, Law S, Murthy S, Alexandrou A, Wong J . Analysis of reduced death and complication rates after esophageal resection. Ann Surg. 2001; 233(3):338-44. PMC: 1421248. DOI: 10.1097/00000658-200103000-00006. View

Stein H, Feith M, Mueller J, Werner M, Siewert J . Limited resection for early adenocarcinoma in Barrett's esophagus. Ann Surg. 2000; 232(6):733-42. PMC: 1421266. DOI: 10.1097/00000658-200012000-00002. View

Bartels H, Stein H, Siewert J . Preoperative risk analysis and postoperative mortality of oesophagectomy for resectable oesophageal cancer. Br J Surg. 1998; 85(6):840-4. DOI: 10.1046/j.1365-2168.1998.00663.x. View

Swisher S, Deford L, Merriman K, Walsh G, Smythe R, Vaporicyan A . Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2000; 119(6):1126-32. DOI: 10.1067/mtc.2000.105644. View

Begg C, Cramer L, Hoskins W, Brennan M . Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998; 280(20):1747-51. DOI: 10.1001/jama.280.20.1747. View

Akiyama H, Tsurumaru M, Udagawa H, Kajiyama Y . Radical lymph node dissection for cancer of the thoracic esophagus. Ann Surg. 1994; 220(3):364-72; discussion 372-3. PMC: 1234394. DOI: 10.1097/00000658-199409000-00012. View

Rice T, Zuccaro Jr G, Adelstein D, Rybicki L, Blackstone E, Goldblum J . Esophageal carcinoma: depth of tumor invasion is predictive of regional lymph node status. Ann Thorac Surg. 1998; 65(3):787-92. DOI: 10.1016/s0003-4975(97)01387-8. View

Orringer M, Marshall B, Iannettoni M . Transhiatal esophagectomy: clinical experience and refinements. Ann Surg. 1999; 230(3):392-400; discussion 400-3. PMC: 1420884. DOI: 10.1097/00000658-199909000-00012. View

10.

Dudley R, Johansen K, Brand R, Rennie D, Milstein A . Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA. 2000; 283(9):1159-66. DOI: 10.1001/jama.283.9.1159. View

11.

Nigro J, Hagen J, DeMeester T, Demeester S, Peters J, Oberg S . Prevalence and location of nodal metastases in distal esophageal adenocarcinoma confined to the wall: implications for therapy. J Thorac Cardiovasc Surg. 1998; 117(1):16-23; discussion 23-5. DOI: 10.1016/s0022-5223(99)70464-2. View

12.

Natsugoe S, Mueller J, Stein H, Feith M, Hofler H, Siewert J . Micrometastasis and tumor cell microinvolvement of lymph nodes from esophageal squamous cell carcinoma: frequency, associated tumor characteristics, and impact on prognosis. Cancer. 1998; 83(5):858-66. View

13.

Izbicki J, Scheunemann P, Knoefel W, Hosch S . Micrometastases and Microinvolvement in Esophageal Carcinoma. Concerning Feith et al.: Clinical relevance of lymph node micrometastases in esophageal carcinoma. Onkologie 2000;23:330-333. Onkologie. 2001; 23(5):478-479. DOI: 10.1159/000027209. View

14.

Geh J, Crellin A, Glynne-Jones R . Preoperative (neoadjuvant) chemoradiotherapy in oesophageal cancer. Br J Surg. 2001; 88(3):338-56. DOI: 10.1046/j.1365-2168.2001.01670.x. View

15.

Lerut T, Coosemans W, Van Raemdonck D, Dillemans B, De Leyn P, Marnette J . Surgical treatment of Barrett's carcinoma. Correlations between morphologic findings and prognosis. J Thorac Cardiovasc Surg. 1994; 107(4):1059-65; discussion 1065-6. DOI: 10.1007/978-4-431-68246-2_25. View

16.

Hagen J, Peters J, DeMeester T . Superiority of extended en bloc esophagogastrectomy for carcinoma of the lower esophagus and cardia. J Thorac Cardiovasc Surg. 1993; 106(5):850-8; discussion 858-9. View

17.

Lerut T, De Leyn P, Coosemans W, Van Raemdonck D, Scheys I, Lesaffre E . Surgical strategies in esophageal carcinoma with emphasis on radical lymphadenectomy. Ann Surg. 1992; 216(5):583-90. PMC: 1242677. DOI: 10.1097/00000658-199211000-00010. View

18.

Stein H, Sendler A, Fink U, Siewert J . Multidisciplinary approach to esophageal and gastric cancer. Surg Clin North Am. 2000; 80(2):659-82; discussions 683-6. DOI: 10.1016/s0039-6109(05)70205-x. View

19.

Muller J, Erasmi H, Stelzner M, Zieren U, Pichlmaier H . Surgical therapy of oesophageal carcinoma. Br J Surg. 1990; 77(8):845-57. DOI: 10.1002/bjs.1800770804. View

20.

Siewert J, Stein H . Lymph-node dissection in squamous cell esophageal cancer -- who benefits?. Langenbecks Arch Surg. 1999; 384(2):141-8. DOI: 10.1007/s004230050184. View