Evolving progress in oncologic and operative outcomes for esophageal and junctional cancer : lessons from the experience of a high-volume center

Reynolds, John V., Donohoe, Claire L., McGillycuddy, Erin, Ravi, Naraymasamy, O'Toole, Dermot, O'Byrne, Kenneth J., & Hollywood, Donal (2012) Evolving progress in oncologic and operative outcomes for esophageal and junctional cancer : lessons from the experience of a high-volume center. Journal of Thoracic and Cardiovascular Surgery, 143(5), 1130-1137.e1.

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Objective: Modern series from high-volume esophageal centers report an approximate 40% 5-year survival in patients treated with curative intent and postoperative mortality rates of less than 4%. An objective analysis of factors that underpin current benchmarks within high-volume centers has not been performed.

Methods: Three time periods were studied, 1990 to 1998 (period 1), 1999 to 2003 (period 2), and 2004 to 2008 (period 3), in which 471, 254, and 342 patients, respectively, with esophageal cancer were treated with curative intent. All data were prospectively recorded, and staging, pathology, treatment, operative, and oncologic outcomes were compared.

Results: Five-year disease-specific survival was 28%, 35%, and 44%, and in-hospital postoperative mortality was 6.7%, 4.4%, and 1.7% for periods 1 to 3, respectively (P < .001). Period 3, compared with periods 1 and 2, respectively, was associated with significantly (P < .001) more early tumors (17% vs 4% and 6%), higher nodal yields (median 22 vs 11 and 18), and a higher R0 rate in surgically treated patients (81% vs 73% and 75%). The use of multimodal therapy increased (P < .05) across time periods. By multivariate analysis, age, T stage, N stage, vascular invasion, R status, and time period were significantly (P < .0001) associated with outcome.

Conclusions: Improved survival with localized esophageal cancer in the modern era may reflect an increase of early tumors and optimized staging. Important surgical and pathologic standards, including a higher R0 resection rate and nodal yields, and lower postoperative mortality, were also observed. Copyright © 2012 by The American Association for Thoracic Surgery.

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10 citations in Web of Science®
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ID Code: 65375
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: adult, aged, article, cancer localization, cancer mortality, cancer specific survival, cancer staging, cancer surgery, cancer survival, cancer therapy, disease specific survival, early cancer, esophageal adenocarcinoma, esophageal squamous cell carcinoma, esophagus cancer, esophagus resection, female, human, lower esophagus sphincter, lymphoma, major clinical study, male, multimodality cancer therapy, priority journal, prospective study, small cell carcinoma, surgical mortality, treatment outcome, tumor regression, Adenocarcinoma, Age Factors, Carcinoma, Squamous Cell, Chemoradiotherapy, Adjuvant, Chi-Square Distribution, Disease-Free Survival, Esophageal Neoplasms, Esophagectomy, Esophagogastric Junction, Gastrectomy, Hospital Mortality, Hospitals, Humans, Ireland, Kaplan-Meier Estimate, Lymph Node Excision, Multivariate Analysis, Neoadjuvant Therapy, Neoplasm Invasiveness, Neoplasm Staging, Proportional Hazards Models, Prospective Studies, Risk Assessment, Risk Factors, Time Factors
DOI: 10.1016/j.jtcvs.2011.12.003
ISSN: 0022-5223
Divisions: Current > Schools > School of Biomedical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2012 Mosby, Inc.
Deposited On: 13 Dec 2013 00:05
Last Modified: 17 Mar 2014 00:29

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