Factors Affecting Postoperative Course and Survival After En Bloc Resection for Esophageal Carcinoma
To identify factors affecting postoperative course and survival after esophagectomy for cancer and reasons for improved survival over time. Complete esophageal resection was attempted for middle and lower third esophageal carcinomas in 386 consecutive patients between January 1982 and January 2002....
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| Published in | The Annals of thoracic surgery Vol. 78; no. 4; pp. 1177 - 1183 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
| Published |
New York, NY
Elsevier Inc
01.10.2004
Elsevier Science Elsevier |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0003-4975 1552-6259 1552-6259 |
| DOI | 10.1016/j.athoracsur.2004.02.068 |
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| Abstract | To identify factors affecting postoperative course and survival after esophagectomy for cancer and reasons for improved survival over time.
Complete esophageal resection was attempted for middle and lower third esophageal carcinomas in 386 consecutive patients between January 1982 and January 2002. Two study periods were analyzed: 1982 to 1993 and 1994 to 2002. Prognostic factors were identified by multivariate analysis and the two periods compared.
Hospital mortality rate decreased from 5.4% to 2.9% (
p = 0.245). Both anastomotic leakage and pulmonary complications rates decreased from 9.8% to 2.2% (
p = 0.001) and 24.1% to 19.3% (
p = 0.295), respectively. An increased proportion of patients had R0 resection in the latter period, 78.5% versus 67.0%, (
p = 0.028). Five-year survival rate after R0 resection increased from 29% to 46% (
p = 0.001), with a decreased recurrence rate from 65.8% to 44.3% (
p = 0.002). Three favorable prognostic factors were identified: low pT stage, pN0 stage, and operation during the 1994 to 2002 study period.
Short-term outcome and survival of patients with resected esophageal cancer have improved over time. Advances in perioperative technique, staging methods, and surgical management combined with higher patient selection and use of neoadjuvant chemoradiation may be responsible for this progress. |
|---|---|
| AbstractList | To identify factors affecting postoperative course and survival after esophagectomy for cancer and reasons for improved survival over time.BACKGROUNDTo identify factors affecting postoperative course and survival after esophagectomy for cancer and reasons for improved survival over time.Complete esophageal resection was attempted for middle and lower third esophageal carcinomas in 386 consecutive patients between January 1982 and January 2002. Two study periods were analyzed: 1982 to 1993 and 1994 to 2002. Prognostic factors were identified by multivariate analysis and the two periods compared.METHODSComplete esophageal resection was attempted for middle and lower third esophageal carcinomas in 386 consecutive patients between January 1982 and January 2002. Two study periods were analyzed: 1982 to 1993 and 1994 to 2002. Prognostic factors were identified by multivariate analysis and the two periods compared.Hospital mortality rate decreased from 5.4% to 2.9% (p = 0.245). Both anastomotic leakage and pulmonary complications rates decreased from 9.8% to 2.2% (p = 0.001) and 24.1% to 19.3% (p = 0.295), respectively. An increased proportion of patients had R0 resection in the latter period, 78.5% versus 67.0%, (p = 0.028). Five-year survival rate after R0 resection increased from 29% to 46% (p = 0.001), with a decreased recurrence rate from 65.8% to 44.3% (p = 0.002). Three favorable prognostic factors were identified: low pT stage, pN0 stage, and operation during the 1994 to 2002 study period.RESULTSHospital mortality rate decreased from 5.4% to 2.9% (p = 0.245). Both anastomotic leakage and pulmonary complications rates decreased from 9.8% to 2.2% (p = 0.001) and 24.1% to 19.3% (p = 0.295), respectively. An increased proportion of patients had R0 resection in the latter period, 78.5% versus 67.0%, (p = 0.028). Five-year survival rate after R0 resection increased from 29% to 46% (p = 0.001), with a decreased recurrence rate from 65.8% to 44.3% (p = 0.002). Three favorable prognostic factors were identified: low pT stage, pN0 stage, and operation during the 1994 to 2002 study period.Short-term outcome and survival of patients with resected esophageal cancer have improved over time. Advances in perioperative technique, staging methods, and surgical management combined with higher patient selection and use of neoadjuvant chemoradiation may be responsible for this progress.CONCLUSIONSShort-term outcome and survival of patients with resected esophageal cancer have improved over time. Advances in perioperative technique, staging methods, and surgical management combined with higher patient selection and use of neoadjuvant chemoradiation may be responsible for this progress. To identify factors affecting postoperative course and survival after esophagectomy for cancer and reasons for improved survival over time. Complete esophageal resection was attempted for middle and lower third esophageal carcinomas in 386 consecutive patients between January 1982 and January 2002. Two study periods were analyzed: 1982 to 1993 and 1994 to 2002. Prognostic factors were identified by multivariate analysis and the two periods compared. Hospital mortality rate decreased from 5.4% to 2.9% ( p = 0.245). Both anastomotic leakage and pulmonary complications rates decreased from 9.8% to 2.2% ( p = 0.001) and 24.1% to 19.3% ( p = 0.295), respectively. An increased proportion of patients had R0 resection in the latter period, 78.5% versus 67.0%, ( p = 0.028). Five-year survival rate after R0 resection increased from 29% to 46% ( p = 0.001), with a decreased recurrence rate from 65.8% to 44.3% ( p = 0.002). Three favorable prognostic factors were identified: low pT stage, pN0 stage, and operation during the 1994 to 2002 study period. Short-term outcome and survival of patients with resected esophageal cancer have improved over time. Advances in perioperative technique, staging methods, and surgical management combined with higher patient selection and use of neoadjuvant chemoradiation may be responsible for this progress. To identify factors affecting postoperative course and survival after esophagectomy for cancer and reasons for improved survival over time. Complete esophageal resection was attempted for middle and lower third esophageal carcinomas in 386 consecutive patients between January 1982 and January 2002. Two study periods were analyzed: 1982 to 1993 and 1994 to 2002. Prognostic factors were identified by multivariate analysis and the two periods compared. Hospital mortality rate decreased from 5.4% to 2.9% (p = 0.245). Both anastomotic leakage and pulmonary complications rates decreased from 9.8% to 2.2% (p = 0.001) and 24.1% to 19.3% (p = 0.295), respectively. An increased proportion of patients had R0 resection in the latter period, 78.5% versus 67.0%, (p = 0.028). Five-year survival rate after R0 resection increased from 29% to 46% (p = 0.001), with a decreased recurrence rate from 65.8% to 44.3% (p = 0.002). Three favorable prognostic factors were identified: low pT stage, pN0 stage, and operation during the 1994 to 2002 study period. Short-term outcome and survival of patients with resected esophageal cancer have improved over time. Advances in perioperative technique, staging methods, and surgical management combined with higher patient selection and use of neoadjuvant chemoradiation may be responsible for this progress. |
| Author | Triboulet, Jean-Pierre Taillier, Guillaume Mariette, Christophe Van Seuningen, Isabelle |
| Author_xml | – sequence: 1 givenname: Christophe surname: Mariette fullname: Mariette, Christophe email: c-mariette@chru-lille.fr organization: Service de Chirurgie Digestive et Générale, Hôpital Claude Huriez, Lille, France – sequence: 2 givenname: Guillaume surname: Taillier fullname: Taillier, Guillaume organization: Service de Chirurgie Digestive et Générale, Hôpital Claude Huriez, Lille, France – sequence: 3 givenname: Isabelle surname: Van Seuningen fullname: Van Seuningen, Isabelle organization: Unité INSERM 560, Centre Hospitalier Régional Universitaire, Lille, France – sequence: 4 givenname: Jean-Pierre surname: Triboulet fullname: Triboulet, Jean-Pierre organization: Service de Chirurgie Digestive et Générale, Hôpital Claude Huriez, Lille, France |
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| Keywords | 7 Postoperative En bloc resection Prognosis Treatment Respiratory disease Surgery Esophageal disease Digestive diseases Thorax Malignant tumor Survival |
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| Snippet | To identify factors affecting postoperative course and survival after esophagectomy for cancer and reasons for improved survival over time.
Complete esophageal... To identify factors affecting postoperative course and survival after esophagectomy for cancer and reasons for improved survival over time.BACKGROUNDTo... |
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| SubjectTerms | Adenocarcinoma - drug therapy Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - radiotherapy Adenocarcinoma - surgery Adult Aged Antineoplastic Combined Chemotherapy Protocols - therapeutic use Biological and medical sciences Carcinoma, Squamous Cell - drug therapy Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - radiotherapy Carcinoma, Squamous Cell - surgery Chemotherapy, Adjuvant Cisplatin - administration & dosage Cohort Studies Combined Modality Therapy Esophageal Neoplasms - drug therapy Esophageal Neoplasms - mortality Esophageal Neoplasms - pathology Esophageal Neoplasms - radiotherapy Esophageal Neoplasms - surgery Esophagectomy - methods Esophagectomy - statistics & numerical data Female Fluorouracil - administration & dosage Follow-Up Studies Hospital Mortality Humans Life Sciences Male Medical sciences Middle Aged Multivariate Analysis Neoplasm Recurrence, Local - epidemiology Neoplasm Staging Postoperative Complications - epidemiology Preoperative Care Prognosis Radiotherapy, Adjuvant Retrospective Studies Risk Factors Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Surgery of the respiratory system Survival Analysis Survival Rate Tomography, X-Ray Computed |
| Title | Factors Affecting Postoperative Course and Survival After En Bloc Resection for Esophageal Carcinoma |
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