PREDICTION OF OUTCOME IN RESECTABLE ESOPHAGEAL-CARCINOMA

A retrospective review was performed of 51 patients with esophageal ca rcinoma, deemed ''resectable'' by preoperative workup (e.g., CT scan, barium swallow), who presented to Hahnemann University Hospital betwee n 1980 and 1991. This represented 21.8% of the total number of patient s (234) with esophageal cancer who presented during that time period. At exploration, only 21 of the 51 patients (41%, or 9% overall) were t ruly resectable; 59% had more extensive disease than was appreciated p reoperatively and that precluded resection for cure. Of the 21 patient s resected for cure, 24% were alive at two years and only 5% were aliv e at 3 years. Neither age, gender, tumor type nor location in the esop hagus significantly affected overall survival. Furthermore, none of th ese parameters, taken as independent variables, were able to predict t rue resectability at the time of operation. We conclude that preoperat ive assessment of resectability, even in those patients who appear to be good candidates for cure, remains imprecise at best. Given an opera tive mortality rate of 6-8% (in most series) and an overall 3- to 5-ye ar survival rate of less than 10% (even in patients thought to have ha d curative resections), we reinforce the fact that meticulous patient selection and multimodality management strategies remain the keys to m aking any impact on this disease. (C) 1993 Wiley-Liss, Inc.