Patients and Methods
Patient Population
Staging
Treatment
Pathology
Follow-Up and Definition of Recurrence
Statistical Analysis
Results
Baseline Demographics
Patient Presentation
Overall | 1989–1993 | 1994–1998 | 1995–2003 | 1995–2008 | 2009–2013 | 2014–2018 | p value | |
---|---|---|---|---|---|---|---|---|
n | 1486 | 41 | 170 | 240 | 245 | 380 | 410 | |
Age at presentation, years (median [IQR]) | 65 [59–71] | 64 [58–70] | 64 [57–70] | 65 [56–71] | 65 [58–71] | 65 [59–72] | 66 [60–71] | 0.159 |
Male sex | 1105 (75) | 29 (71) | 130 (76) | 169 (70) | 180 (73) | 277 (73) | 320 (78) | 0.297 |
SCC histology | 372 (25) | 19 (46) | 54 (32) | 63 (26) | 53 (22) | 90 (24) | 93 (23) | 0.004 |
BMI (median [IQR]) | 26 [23–29] | 24 [21–26] | 24 [21–28] | 25 [22–28] | 26 [24–29] | 26 [23–29] | 27 [24–30] | < 0.001 |
Smoking status | < 0.001 | |||||||
Current | 371 (25) | 19 (46) | 61 (36) | 79 (33) | 58 (24) | 74 (19) | 80 (20) | |
Ex-smoker | 649 (44) | 10 (24) | 63 (37) | 97 (40) | 110 (45) | 186 (49) | 183 (45) | |
Never | 448 (30) | 10 (24) | 45 (26) | 63 (26) | 75 (31) | 113 (30) | 142 (35) | |
Unknown | 18 (1) | 2 (5) | 1 (1) | 1 (0) | 2 (1) | 7 (2) | 5 (1) | |
Alcohol status | < 0.001 | |||||||
Current | 1067 (72) | 30 (73) | 104 (61) | 170 (71) | 180 (73) | 268 (71) | 315 (77) | |
Ex-drinker | 91 (6) | 1 (2) | 4 (2) | 10 (4) | 28 (11) | 28 (7) | 20 (5) | |
Never | 284 (19) | 5 (12) | 36 (21) | 50 (21) | 37 (15) | 81 (21) | 75 (18) | |
Unknown | 44 (3) | 5 (12) | 26 (15) | 10 (4) | 0 (0) | 3 (1) | 0 (0) | |
ASA grade | < 0.001 | |||||||
1 | 211 (14) | 6 (15) | 50 (29) | 34 (14) | 35 (14) | 72 (19) | 14 (3) | |
2 | 725 (49) | 15 (37) | 60 (35) | 87 (36) | 131 (53) | 204 (54) | 228 (56) | |
3 | 394 (27) | 3 (7) | 19 (11) | 62 (26) | 56 (23) | 91 (24) | 163 (40) | |
4 | 10 (1) | 1 (2) | 1 (1) | 3 (1) | 2 (1) | 2 (1) | 1 (0) | |
Unknown | 146 (10) | 16 (39) | 40 (24) | 54 (22) | 21 (9) | 11 (3) | 4 (1) | |
Reported weight loss | 773 (52) | 30 (73) | 103 (61) | 142 (59) | 128 (52) | 197 (52) | 173 (42) | < 0.001 |
Anorexia | 193 (13) | 13 (32) | 43 (25) | 44 (18) | 41 (17) | 35 (9) | 17 (4) | < 0.001 |
Epigastric discomfort | 610 (41) | 4 (10) | 29 (17) | 73 (30) | 99 (40) | 120 (32) | 285 (70) | < 0.001 |
Epigastric pain | 296 (20) | 9 (22) | 45 (26) | 66 (28) | 36 (15) | 74 (19) | 66 (16) | 0.001 |
Retrosternal pain | 313 (21) | 10 (24) | 29 (17) | 70 (29) | 72 (29) | 76 (20) | 56 (14) | < 0.001 |
Vomiting/regurgitation | 501 (34) | 23 (56) | 87 (51) | 103 (43) | 85 (35) | 115 (30) | 88 (21) | < 0.001 |
Dysphagia | 0.449 | |||||||
Unknown | 17 (1) | 1 (2) | 1 (1) | 2 (1) | 1 (0) | 6 (2) | 6 (1) | |
Can eat normally | 404 (27) | 4 (10) | 37 (22) | 68 (28) | 77 (31) | 102 (27) | 116 (28) | |
Difficulty with solids | 678 (46) | 22 (54) | 93 (55) | 101 (42) | 110 (45) | 176 (46) | 176 (43) | |
Liquids only | 75 (5) | 2 (5) | 8 (5) | 13 (5) | 14 (6) | 13 (3) | 25 (6) | |
Soft or liquid food only | 290 (20) | 11 (27) | 28 (16) | 51 (21) | 41 (17) | 78 (21) | 81 (20) | |
Total dysphagia | 22 (1) | 1 (2) | 3 (2) | 5 (2) | 2 (1) | 5 (1) | 6 (1) | |
Odynophagia | 287 (19) | 10 (24) | 45 (26) | 57 (24) | 50 (20) | 77 (20) | 48 (12) | < 0.001 |
Nausea | 133 (9) | 5 (12) | 21 (12) | 29 (12) | 14 (6) | 32 (8) | 32 (8) | 0.082 |
Jaundice | 4 (0) | 0 (0) | 0 (0) | 1 (0) | 1 (0) | 2 (1) | 0 (0) | 0.703 |
Hepatomegaly | 5 (0) | 0 (0) | 1 (1) | 3 (1) | 0 (0) | 1 (0) | 0 (0) | 0.121 |
Anemia | 102 (7) | 0 (0) | 12 (7) | 16 (7) | 15 (6) | 20 (5) | 39 (10) | 0.098 |
Reflux | 376 (25) | 7 (17) | 69 (41) | 45 (19) | 48 (20) | 105 (28) | 102 (25) | < 0.001 |
Changes in Staging
Changes in Pathology
Overall | 1989–1993 | 1994–1998 | 1995–2003 | 2003–2008 | 2009–2013 | 2014–2018 | p value | |
---|---|---|---|---|---|---|---|---|
n | 1486 | 41 | 170 | 240 | 245 | 380 | 410 | |
Overall clinical stage | < 0.001 | |||||||
I | 249 (17) | 27 (66) | 54 (32) | 22 (9) | 35 (14) | 47 (12) | 64 (16) | |
IIA | 102 (7) | 5 (12) | 26 (15) | 18 (8) | 12 (5) | 16 (4) | 25 (6) | |
IIB | 68 (5) | 1 (2) | 8 (5) | 16 (7) | 12 (5) | 9 (2) | 22 (5) | |
III | 835 (56) | 6 (15) | 74 (44) | 180 (75) | 182 (74) | 206 (54) | 187 (46) | |
IVA | 224 (15) | 2 (5) | 8 (5) | 3 (1) | 3 (1) | 99 (26) | 109 (27) | |
IVB | 8 (1) | 0 (0) | 0 (0) | 1 (0) | 1 (0) | 3 (1) | 3 (1) | |
Overall pathological stage | < 0.001 | |||||||
0/I | 84 (6) | 0 (0) | 6 (4) | 9 (4) | 12 (5) | 12 (3) | 45 (11) | |
IA | 85 (6) | 0 (0) | 15 (9) | 26 (11) | 20 (8) | 11 (3) | 13 (3) | |
IB | 162 (11) | 6 (15) | 10 (6) | 17 (7) | 22 (9) | 46 (12) | 61 (15) | |
IC | 76 (5) | 1 (2) | 4 (2) | 10 (4) | 14 (6) | 26 (7) | 21 (5) | |
IIA | 92 (6) | 3 (7) | 13 (8) | 8 (3) | 12 (5) | 30 (8) | 26 (6) | |
IIB | 226 (15) | 6 (15) | 16 (9) | 31 (13) | 46 (19) | 68 (18) | 59 (14) | |
IIIA | 122 (8) | 8 (20) | 20 (12) | 19 (8) | 23 (9) | 23 (6) | 29 (7) | |
IIIB | 506 (34) | 17 (41) | 79 (46) | 106 (44) | 87 (36) | 111 (29) | 106 (26) | |
IVA | 122 (8) | 0 (0) | 6 (4) | 12 (5) | 8 (3) | 49 (13) | 47 (11) | |
IVB | 6 (0) | 0 (0) | 1 (1) | 2 (1) | 0 (0) | 2 (1) | 1 (0) | |
Unknown | 5 (0) | 0 (0) | 0 (0) | 0 (0) | 1 (0) | 2 (1) | 2 (0) | |
Tumor grade | < 0.001 | |||||||
Well-differentiated | 136 (9) | 7 (17) | 29 (17) | 32 (13) | 30 (12) | 16 (4) | 22 (5) | |
Moderately differentiated | 683 (46) | 15 (37) | 61 (36) | 123 (51) | 108 (44) | 198 (52) | 178 (43) | |
Poorly differentiated | 516 (35) | 14 (34) | 66 (39) | 67 (28) | 84 (34) | 140 (37) | 145 (35) | |
Unknown | 151 (10) | 5 (12) | 14 (8) | 18 (8) | 23 (9) | 26 (7) | 65 (16) | |
Lymph nodes examined (median [IQR]) | 29 [21–39] | 10 [7–13] | 19 [13–24] | 27 [19–34] | 34 [26–42] | 30 [23–38] | 34 [27–45] | < 0.001 |
Lymph nodes positive (median [IQR]) | 1 [0–4] | 1 [0–4] | 1 [0–5] | 1 [0–5] | 1 [0–4] | 1 [0–3] | 0 [0–3] | 0.001 |
Proximal margin R1 | 9 (1) | 0 (0) | 0 (0) | 0 (0) | 2 (1) | 6 (2) | 1 (0) | 0.081 |
Distal margin R1 | 13 (1) | 0 (0) | 0 (0) | 0 (0) | 1 (0) | 1 (0) | 11 (3) | 0.001 |
Lymphatic invasion | 635 (43) | 3 (7) | 59 (35) | 110 (46) | 116 (47) | 186 (49) | 161 (39) | < 0.001 |
Venous invasion | 476 (32) | 2 (5) | 39 (23) | 77 (32) | 83 (34) | 154 (41) | 121 (30) | < 0.001 |
Perineural invasion | 626 (42) | 14 (34) | 68 (40) | 125 (52) | 115 (47) | 162 (43) | 142 (35) | < 0.001 |
Extracapsular spread | 225 (15) | 0 (0) | 0 (0) | 0 (0) | 25 (10) | 105 (28) | 95 (23) | < 0.001 |
Patient Outcomes
Overall | 1989–1993 | 1994–1998 | 1995–2003 | 2003–2008 | 2009–2013 | 2014–2018 | p value | |
---|---|---|---|---|---|---|---|---|
n | 1486 | 41 | 170 | 240 | 245 | 380 | 410 | |
Operation type (%) | < 0.001 | |||||||
Ivor Lewis | 1429 (96) | 39 (95) | 163 (96) | 237 (99) | 237 (97) | 367 (97) | 386 (94) | |
Left thoraco-abdominal | 15 (1) | 2 (5) | 2 (1) | 3 (1) | 5 (2) | 2 (1) | 1 (0) | |
McKeown | 38 (3) | 0 (0) | 1 (1) | 0 (0) | 3 (1) | 11 (3) | 23 (6) | |
Transhiatal | 4 (0) | 0 (0) | 4 (2) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | |
Unimodality surgery | 754 (51) | 41 (100) | 168 (99) | 201 (84) | 105 (43) | 119 (31) | 120 (29) | < 0.001 |
Surgical access thoracic phase | ||||||||
Open | 1431 (96) | 41 (100) | 170 (100) | 240 (100) | 245 (100) | 376 (99) | 359 (88) | |
Thoracoscopic | 46 (3) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 46 (11) | |
Thoracoscopic converted | 4 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 4 (1) | |
Surgical access abdominal phase | ||||||||
Open | 1468 (99) | 41 (100) | 170 (100) | 240 (100) | 245 (100) | 363 (96) | 409 (100) | |
Laparoscopic | 12 (1) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 12 (3) | 0 (0) | |
Laparoscopic converted | 6 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 5 (1) | 1 (0) | |
Critical care stay (median [IQR]) | 2 [1–5] | 2 [1–3] | 1 [1–3] | 3 [1–8] | 2 [1–5] | 3 [1–5] | 3 [2–5] | < 0.001 |
Length of stay (median [IQR]) | 15 [12–22] | 14 [12–18] | 13 [12–16] | 17 [14–27] | 16 [14–25] | 16 [13–25] | 11 [8–18] | < 0.001 |
Overall complications | 963 (65) | 22 (54) | 93 (55) | 172 (72) | 159 (65) | 239 (63) | 278 (68) | 0.004 |
Surgical site infection | 130 (9) | 0 (0) | 8 (5) | 33 (14) | 30 (12) | 27 (7) | 32 (8) | 0.001 |
Pulmonary complications | 188 (13) | 1 (2) | 3 (2) | 9 (4) | 11 (4) | 72 (19) | 92 (22) | < 0.001 |
Cardiac complications | 107 (7) | 0 (0) | 1 (1) | 2 (1) | 2 (1) | 40 (11) | 62 (15) | < 0.001 |
Anastomotic leaks | 126 (8) | 3 (7) | 10 (6) | 17 (7) | 26 (11) | 33 (9) | 37 (9) | 0.584 |
In-hospital mortality | 58 (4) | 2 (5) | 11 (6) | 15 (6) | 10 (4) | 7 (2) | 13 (3) | 0.042 |
30-day mortality | 43 (3) | 2 (5) | 10 (6) | 13 (5) | 6 (2) | 2 (1) | 10 (2) | 0.002 |
90-day mortality | 69 (5) | 3 (7) | 15 (9) | 16 (7) | 15 (6) | 8 (2) | 12 (3) | 0.001 |