MORBIDITY, ABILITY TO SWALLOW, AND SURVIVAL, AFTER ESOPHAGECTOMY FOR CANCER OF THE ESOPHAGUS AND CARDIA

Objective: To study survival, morbidity, and ability to swallow, after oesophagectomy for cancer of the oesophagus and cardia. Design: Prosp ective open study. Setting: University hospital, Norway. Subjects: 83 patients, 38 with squamous cell carcinoma and 35 with adenocarcinoma o f the oesophagus and cardia. Interventions: Transhiatal (n = 51) and t ransthoracic (n = 32) oesophagectomy. Oesophageal replacement was by e ither stomach (n = 80) or colon (n = 3). Cervical anastomosis was used in all but 2. Main outcome measures: Early and late morbidity and mor tality, length of stay in intensive care unit and in hospital, and sur vival analysis. Results: 30 Day and in hospital mortality were 0 and 4 % for transhiatal, and 6% and 9% for transthoracic, oesophagectomy. Co mplications included recurrent nerve palsy (n = 7), anastomotic leaks (n = 5), and chylothorax (n = 4). 17 Patients (22%) needed dilatations for stenosis of the anastomosis, and 71 (85%) of the patients left ho spital within four weeks of operation. Survival analysis showed a 5 ye ar survival rate of 33% for patients with adenocarcinoma operated on f or cure and a 2 year survival of 28% for patients with; squamous cell carcinoma. Conclusions: Oesophagectomy for cure is worthwhile as some patients are cured and most of the remainder have prolonged relief of their dysphagia. Palliative resections should not be done in patients with distant metastases or invasion of adjacent organs by the tumour b ecause of long stay in hospital, appreciable morbidity, and short life expectancy.