A 15-Year Review of Esophagectomy for Carcinoma of the Esophagus and Cardia

Abstract

Objective: To evaluate the effect of surgical approach and adjuvant therapy on patients with carcinoma of the esophagus and/or cardia. Design: Retrospective analysis of 157 consecutive patients who underwent esophagectomy. Setting: A private university medical center and its affiliated community hospital. Patients: 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. Interventions: Three approaches were used for resection: Transhiatal esophagectomy (THE) (n=67), transthoracic esophagectomy (TTE) (n=71), and abdominalonly 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. Results: 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). Conclusions: 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. (Arch Surg. 1995;130:617-624)