A 15-Year Review of Esophagectomy for Carcinoma of the Esophagus and Cardia
Millikan KW, Silverstein J, Hart V, Blair K, Bines S, Roberts J, Doolas A. A 15-Year Review of Esophagectomy for Carcinoma of the Esophagus and Cardia. Arch Surg. 1995 Jun; 130(6):617-24.
To evaluate the effect of surgical approach and adjuvant therapy on patients with carcinoma of the esophagus and/or cardia.
Retrospective analysis of 157 consecutive patients who underwent esophagectomy.
A private university medical center and its affiliated community hospital.
One hundred twenty men and 37 women (mean age, 61.7 years) with carcinoma of the esophagus and/or cardia that was surgically treated between 1978 and 1993.
Three approaches were used for resection: Transhiatal esophagectomy (THE) (n = 67), transthoracic esophagectomy (TTE) (n = 71), and abdominal-only esophagectomy (AOE) (n = 19). Sixty-five patients received adjuvant radiotherapy and chemotherapy.
MAIN OUTCOME MEASURES:
Surgical mortality, morbidity, and survival and the effect of adjuvant therapy.
The overall surgical mortality rate was 7.6%: 12.7% with the TTE, 4.5% with the THE, and 0% with the AOE approach. A significantly increased incidence of adult respiratory distress syndrome (P < .001) and empyema (P < .001) was seen with the TTE approach. The average intraoperative blood loss (P = .08) and the median intensive care unit stay (P = .26) and hospital stay (P = .40) were decreased with the THE and AOE approaches when compared with the TTE approach without significance. The overall median survival time was 17 months, with a 5-year survival rate of 21%. There was no significant difference in survival by pathologic stage between approaches. The addition of adjuvant therapy did not affect the overall median survival time or the 5-year survival rate. Node-positive patients did benefit from adjuvant radiotherapy and chemotherapy, with increased median survival times from 7 to 15 months and a 5-year survival rate from 0% to 15% (P = .01).
The THE and AOE approaches have fewer early complications than does TTE. Both THE and TTE have equal long-term survival rates. Adjuvant therapy provides increased survival to node-positive patients with carcinoma of the esophagus and/or cardia.