Prognostic factors after extended esophagectomy for squamous cell carcinoma of the thoracic esophagus

Backgrounds and Objectives: In Japan, extended esophagectomy with extensive lymphadenectomy has become the standard surgical procedure for carcinoma o f the thoracic esophagus. Although mortality and morbidity rates after such extensive esophagectomy have been acceptable, the long-term outcomes are n ot necessarily satisfactory. Methods: Among 235 patients with primary squamous cell carcinoma of the tho racic esophagus between June 1981 and March 1998, 143 patients (60.9%) unde rwent extended esophagectomy with extensive lymphadenectomy. To exclude the effects of surgery-related postoperative complications, 14 patients who di ed within 90 days after operation were excluded. Thus, clinicopathological characteristics and prognostic factors of 129 patients were retrospectively investigated. Results: Sixty-three patients were alive and free of cancer. Sixty-six pati ents died: 37 of recurrence of the esophageal cancer and 29 of other causes . The 1-, 3-, 5-, and 10-year overall survival rates in the 129 patients we re 78.8%, 53.5%, 45.8%, and 30.9%, respectively, and the disease-specific s urvival rates were 85.7%, 69.1%, 67.9%, and 56.2%, respectively. The factor s influencing the disease-specific survival rate were tumor location (upper third vs, non-upper third), Borrmann classification (0, 1 vs. 2, 3), size of tumor (less than or equal to 3.0 vs. >3.0 cm), depth of invasion (T1, 2 vs. T3, 4), number of lymph node metastases (0 or I vs. greater than or equ al to 2), time of operation (less than or equal to 420 vs. >420 min), amoun t of blood transfused (less than or equal to 2 vs. greater than or equal to 3 U), lymph vessel invasion (marked vs. not marked), and blood vessel inva sion (marked vs. not marked). Among those significant variables, independen t prognostic factors for survival determined by multivariate analysis were number of lymph node metastases (P < 0.001), amount of blood transfusions ( P = 0.0016), and tumor location (P = 0.0382). Conclusions: Patients with a single metastatic node after extended esophage ctomy should be considered to have excellent prognosis, like patients with pN0 tumors. Patients with multiple involved nodes should receive aggressive postoperative adjuvant treatments. Reduced blood loss during extended esop hagectomy and minimal blood transfusions might improve the outcome of curat ive esophageal resections. (C) 1999 Wiley-Liss, Inc.