Original article
General thoracic
Early Recurrence and Death After Esophagectomy in Patients With Esophageal Squamous Cell Carcinoma

https://doi.org/10.1016/j.athoracsur.2011.01.007Get rights and content

Background

The aim of this retrospective study is to analyze recurrence and death within 1 year after esophagectomy in patients with esophageal carcinoma.

Methods

The records of 533 consecutive patients with esophageal squamous cell carcinoma who underwent surgery from January 2002 to January 2005 were reviewed. Patients who died of recurrence within 1 year after operation (group A) were compared with patients who survived more than 5 years without any recurrence (group B). Their clinicopathologic characteristics were evaluated by univariate and multivariate analyses.

Results

The overall 1-year and 5-year survival rates for the entire cohort were 76.1% and 32.3%, respectively, with the follow-up rate of 93.4%. Of the 119 patients who died within 1 year after the esophagectomy, local recurrence or distant metastasis or both were documented in 62 patients (52.1%). The radicality of resection, size of tumor, radicality of resection, grade of differentiation, depth of invasion, status of lymph node metastasis, number of lymph node metastases, and marginal status were shown by univariate analysis to be the significant prognostic factors. By multivariate analysis, they were also the independent prognostic factors, except for the size of tumor and the radicality of resection.

Conclusions

More than half of early death in esophageal squamous cell carcinoma patients after esophagectomy were still tumor recurrence related, especially hematogeneous spreading. The grade of differentiation, depth of invasion, lymph node metastasis, number of lymph node metastases, and marginal status are valuable prognostic factors in predicting early death.

Section snippets

Patient Demographics

Five hundred and thirty-three consecutive patients with thoracic esophageal squamous cell carcinoma underwent esophagectomy in our institution from January 2002 to January 2005. There were 469 men and 64 women, with the age range from 40 to 90 years (median age, 62 years). The diagnosis was established by initial barium esophagogram followed by endoscopic biopsies with documented carcinoma as histologic evidence. The diseases were staged according to the American Joint Committee on Cancer

Results

There were 8 operative deaths (within 30 days after operation), for an operative mortality of 1.5%. The mean number of lymph node resections was 16.4, and the number of positive nodes was 827 of 8,741. The survival and recurrence status could be ascertained in 498 of 533 patients, with a 5-year follow-up rate of 93.4%. There were 440 men and 58 women. The median follow-up of these patients was 35 months (range, 1 to 89 months).

Comment

Because similar treatment often results in a different outcome for patients with esophageal cancer, an individualized therapy for these patients has been of great interest [8]. Accurate prediction of response to a given therapy is the prerequisite of therapy individualization. If patients cannot survive longer than the natural course of esophageal cancer after their operation, the surgical therapy then should not be recommended. Therefore, the understanding of the pattern of death and risk

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