EN-BLOC ESOPHAGECTOMY IMPROVES SURVIVAL FOR STAGE-III ESOPHAGEAL CANCER

Objective: The role of en bloc esophagectomy in the surgical treatment of patients with locally advanced esophageal cancer is not well defin ed. This report attempts to elucidate its impact on survival, in compa rison with less extensive resection, among patients with stage III dis ease. Methods: A prospectively established database was retrospectivel y analyzed. Results: One hundred twenty-eight patients underwent esoph agectomy for carcinoma of the thoracic esophagus between 1988 and 1996 (78 underwent en bloc resection and 50 underwent standard resection). The 30-day and hospital mortality rates were 3.9% and 5.4%, respectiv ely, comparable for the two procedures. Fifty-four patients had stage III disease. Overall 4-year survival was 34.5% after en bloc resection , with a median survival of 17 months (n = 33), and 11% after standard resection (n = 21), with a median survival of 12 months (p = 0.007). Among patients with stage III disease undergoing a complete resection, 4-year survivals were 36.7% and 0% after en bloc and standard resecti ons, respectively (p = 0.001). Eighty-six of 128 patients had nodal me tastasis. Three-gear survivals for patients with N1 disease were 33.9% and 13% after en bloc and standard resections, respectively (p = 0.02 ). Conclusion: Among patients with stage III esophageal cancer, en blo c resection appears to significantly improve survival compared with le sser resections. This improvement in survival may be attributable to r esection of nodal disease.