Prognostic factors and patterns of recurrence in esophageal cancer assert arguments for extended two-field transthoracic esophagectomy

• Published in: The American journal of surgery Vol. 200; no. 4; pp. 446 - 453
• Main Authors: Smit, Justin K., M.Sc, Pultrum, Bareld B., M.D, van Dullemen, Hendrik M., M.D., Ph.D, Van Dam, Gooitzen M., M.D., Ph.D, Groen, Henk, M.D., Ph.D, Plukker, John T.M., M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2010; Elsevier; Elsevier Limited
• Subjects: Abdomen; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy; Biopsy, Fine-Needle; Cancer; Cancer therapies; Chemotherapy; Classification; Endosonography; Esophageal cancer; Esophageal Neoplasms - diagnosis; Esophageal Neoplasms - epidemiology; Esophageal Neoplasms - surgery; Esophagectomy - methods; Esophagus; Extended lymphadenectomy; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal surgery; General aspects; Hospitals; Humans; Incidence; Lymph; Lymph Node Excision; Lymph nodes; Lymphatic Metastasis; Lymphatic system; Male; Medical prognosis; Medical sciences; Metastasis; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - prevention & control; Neoplasm Staging; Netherlands - epidemiology; Positron-Emission Tomography; Prognosis; Prognostic factors; Recurrence pattern; Retrospective Studies; Standard deviation; Stomach, duodenum, intestine, rectum, anus; Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival; Survival Rate - trends; Time Factors; Tomography; Tomography, X-Ray Computed; Transthoracic esophagectomy; Tumors; Ultrasonic imaging; Netherlands; Transthoracic esophagectomy; Recurrence pattern; Extended lymphadenectomy; Prognostic factors; Relapse; Prognosis; Digestive system; Esophageal disease; Esophagectomy; Malignant tumor; Esophagus cancer; Esophagus; Medicine; Lymphadenectomy; Treatment; Surgery; Digestive diseases; Cancer
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2009.12.006

Abstract Background High recurrence rates determine the dismal outcome in esophageal cancer. We reviewed our experiences and defined prognostic factors and patterns of recurrences after curatively intended transthoracic esophagectomy. Methods Between January 1991 and December 2005, 212 consecutive patients underwent a radical transthoracic esophagectomy with extended 2-field lymphadenectomy. Recurrence rates, survival, and prognostic factors were analyzed (minimal follow-up period, 2 y). Results Radicality was obtained in 85.6%. The median follow-up period was 26.6 months. The overall recurrence rate at 1, 3, and 5 years was 28%, 44%, and 64%, respectively, and locoregional recurrence rate was 17%, 27%, and 43%, respectively. Overall survival rates, including postoperative deaths, were 45% and 34% at 3 and 5 years, respectively. pT stage and lymph node (LN) ratio greater than .20 were independent prognostic factors for survival and recurrences. Radicality was most prognostic for survival, and for N+ greater than 4 positive LN for recurrences. Conclusions Radicality and LN ratio are strong prognostic factors. High radicality and adequate nodal assessment are guaranteed by an extended transthoracic approach.