Modern 5-Year Survival of Resectable Esophageal Adenocarcinoma: Single Institution Experience with 263 Patients

Portale, Giuseppe; Hagen, Jeffrey A.; Peters, Jeffrey H.; Chan, Linda S.; DeMeester, Steven R.; Gandamihardja, Tasha A.K.; DeMeester, Tom R.

doi:10.1016/j.jamcollsurg.2005.12.022

« Previous Next »Journal of the American College of Surgeons
Volume 202, Issue 4 , Pages 588-596, April 2006

Modern 5-Year Survival of Resectable Esophageal Adenocarcinoma: Single Institution Experience with 263 Patients

Presented at the American College of Surgeons 90th Annual Clinical Congress, New Orleans, LA, October 2004.

Giuseppe Portale, MD
- Division of Thoracic and Foregut Surgery, University of Southern California, Los Angeles, CA
Jeffrey A. Hagen, MD, FACS
- Division of Thoracic and Foregut Surgery, University of Southern California, Los Angeles, CA
Jeffrey H. Peters, MD, FACS
- Department of Surgery, University of Rochester, Rochester, NY
Linda S. Chan, PhD
- Division of Thoracic and Foregut Surgery, University of Southern California, Los Angeles, CA
Steven R. DeMeester, MD, FACS
- Division of Thoracic and Foregut Surgery, University of Southern California, Los Angeles, CA
Tasha A.K. Gandamihardja, MD
- Division of Thoracic and Foregut Surgery, University of Southern California, Los Angeles, CA
Tom R. DeMeester, MD, FACS
- Division of Thoracic and Foregut Surgery, University of Southern California, Los Angeles, CA
- Correspondence address: Tom R DeMeester, MD, 1510 San Pablo St, Los Angeles, CA 90033

Received 14 October 2005; received in revised form 29 November 2005; accepted 27 December 2005.

Background

Surgery, as the mainstay of treatment for localized esophageal cancer, is currently being challenged by the assumed high risk of esophagectomy and the poor longterm survival after resection. Epidemiologic and clinical changes over the past decade indicate that these assumptions should be reevaluated. The aim of this study was to assess the modern outcomes of esophagectomy for adenocarcinoma.

Study design

We studied 263 consecutive patients (215 men, 48 women), who had esophagectomy for adenocarcinoma from 1992 to 2002. Ninety-seven (37%) were stage I, 63 (24%) were stage II, 93 (35%) were stage III, and 10 (4%) were stage IV. Forty-five percent (119 of 263) had curative en bloc resection, 52% (138 of 263) had node involvement, and 18% (48) received neoadjuvant therapy.

Results

Seventeen percent (44 of 263) of the patients were identified in a Barrett’s surveillance program. The frequency of T1N0 adenocarcinoma increased over the study period (p=0.024). The overall 5-year survival was 46.5%, and for the last 5 years of the study was 50.4%. The overall 5-year survival for stage I was 81%; for stage II, 51%; for stage III, 14%; and for stage IV, 0%. Complications occurred in 61% and there were 12 perioperative deaths (4.5%). Cox proportional hazard analysis identified tumor stage and type of resection as independent predictors of survival.

Conclusions

Nearly half of patients undergoing esophagectomy for adenocarcinoma survive ≥5 years. Improvements in survival are associated with increased detection of early stage disease, and a liberal use of en bloc resection. Nonsurgical treatments should be compared with these contemporary outcomes measures.