Esophageal carcinoma. Improved quality of survival with resection
Bluett, M.K.; Sawyers, J.L.; Healy, D.
American Surgeon 53(3): 126-132
1987
ISSN/ISBN: 0003-1348 PMID: 2435199 Document Number: 296054
Twenty years ago the experience with carcinoma of the esophagus at Vanderbilt University [Tennessee, USA] and affiliated hospitals was reported in 263 patients. Overall 5-year survival was 2 percent. Esophagectomy was possible in 89 patients (34%) and was associated with a 32 percent mortality. This study updates the authors' experience with squamous cell carcinoma of the esophagus in 311 patients with squamous cell carcinoma of the esophagus in 311 patients seen from 1966 to 1985. Overall 5-year survival was increased to 6 percent. Esophageal resection was accomplished in 104 patients (33%), with a 10 percent operative mortality and 41 percent complication rate. Multi-variant analysis disclosed that smoking, alcohol use, sex, race, and site of tumor did not influence survival. Actuarial survival rates following esphogeal resection were 51 percent at 1 year, 21 percent at 2 years, and 13 percent at 5 years. These survival rates were not influenced by adjuvant radiotherapy. Radiation therapy was used for attempted cure in 83 patients. Actuarial survival rates following curative doses of radiation were 29 percent at 1 year, 15 percent at 2 years, and 4 percent at 5 years. These survival rates were significantly (P < 0.001) lower than survival rates following esophagectomy. The quality of life following treatment was good or fair in 83 percent of patients undergoing esophagectomy and good or fair in 64 percent of patients receiving "curative" doses of radiation. The results of this review demonstrate that esophageal resection using night the Lewis operation or transhiatal esophagectomy can be done with an acceptable operative mortality, results in prolonged survival, and improves the quality of life.