A 15-YEAR REVIEW OF ESOPHAGECTOMY FOR CARCINOMA OF THE ESOPHAGUS AND CARDIA

Objective: To evaluate the effect of surgical approach and adjuvant th erapy on patients with carcinoma of the esophagus and/or cardia. Desig n: Retrospective analysis of 157 consecutive patients who underwent es ophagectomy. Setting: A private university medical center and its affi liated community hospital. Patients: One hundred twenty men and 37 wom en (mean age, 61.7 years) with carcinoma of the esophagus and/or cardi a that was surgically treated between 1978 and 1993. Interventions: Th ree approaches were used for resection: Transhiatal esophagectomy (THE ) (n=67), transthoracic esophagectomy (TTE) (n=71), and abdominal-only esophagectomy (AGE) (n=19). Sixty-five patients received adjuvant rad iotherapy 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 b lood loss (P=.08) and the median intensive care unit stay (P=.26) and hospital stay (P=.40) were decreased with the THE and AOE ap preaches 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 th e overall median survival time or the 5-year survival rate. Node-posit ive 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 O% to 15% (P=.01). Conclusions: The THE and AOE app roaches have fewer early complications than does TTE. Both THE and TTE have equal long-term survival rates. Adjuvant therapy provides increa sed survival to node-positive patients with carcinoma of the esophagus and/or cardia.