The online version of this article (doi:10.1186/1477-7819-10-130) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
KKO, KS, and AV cooperated in the conception and design of the study and in the collection of the data. ODL validated all pathology reports and SAL assisted in data analysis and interpretation of data. KO drafted the manuscript. All authors read and approved the final manuscript.
The effects of transthoracic or transhiatal esophagectomy on the long-term survival of patients who had adenocarcinoma of the esophagus were compared, as were factors applicable in preoperative stratification of patient treatment.
A cohort of 147 consecutive patients with adenocarcinoma of the esophagus was evaluated for esophagectomy between 1984 and 2000. The patients were followed prospectively and observed survival rates of patients with a transthoracic or transhiatal approach to esophagectomy were compared by standardized mortality ratio (SMR) and relative mortality ratio (RMR) using the expected survival of a matched Norwegian population.
A R0 resection was performed by transthoracic (n = 33) or a transhiatal (n = 55) esophagectomy in 88 (60%) patients with a median age of 61 (range: 35–77) and 70 (42–88) years, respectively (P < 0.001). Tumor stages and other possible risk factors were similar in the two groups. Transthoracic or transhiatal esophagectomy resulted in a median survival time of 20.5 (95% confidence interval (CI): 10.4–57.6) and 16.4 (10.6–28.7) months, respectively. The respective survival rates were 31.2% and 27.8% by 5 years, and 21.3% and 16.6% by 10 years with an overall RMR of 1.14 (P = 0.63). Median survival time in the absence or presence of lymph node metastases was 74.0 (95% CI: 17.5–166.4) and 10.7 (7.9–14.9) months. The corresponding survival rates by 10 years with non-involved or involved nodes were 48.9% and 3.8% respectively (RMR 2.22, P = 0.007). Patients with a pT1-tumor were few and the survival rate was not very different from that of the general population (SMR = 1.7, 95% CI: 0.7–4.1). The median survival time of patients with a pT2-tumor was 30.4 (95% CI: 9.0–142) months and with a pT3-tumor 14 (9.2–16.4) months. The survival rates by 10 years among patients with a pT1 tumor were 57.0% (95% CI: 14.9–78.9), pT2 33.3% (11.8–52.2), and pT3 7.1% (1.9–15.5). The relative mortality for T3 stages compared to T1 stages was statistically significant (RMR = 3.22, P = 0.024).
Transthoracic and transhiatal esophagectomy are both effective approaches for treatment of adenocarcinoma of the esophagus and survival of more than 10 years can be expected without adjuvant chemotherapy. However, increasing depth of tumor invasion and lymph node metastases reduce life expectancy.
Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H: Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002, 347: 1662-1669. 10.1056/NEJMoa022343. CrossRefPubMed
Omloo JM, Lagarde SM, Hulscher JB, Reitsma JB, Fockens P, van Dekken H, ten Kate FJ, Obertop H, Tilanus HW, van Lanschot JJ: Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg. 2007, 246: 992-1000. 10.1097/SLA.0b013e31815c4037. CrossRefPubMed
Rudiger SJ, Feith M, Werner M, Stein HJ: Adenocarcinoma of the esophagogastric junction: results of surgical therapy based on anatomical/topographic classification in 1,002 consecutive patients. Ann Surg. 2000, 232: 353-361. 10.1097/00000658-200009000-00007. CrossRef
UICC: TNM Classification of Malignant Tumours. 2009, New York: Wiley-Blackwell
Orringer MB, Sloan H: Esophagectomy without thoracotomy. J Thorac Cardiovasc Surg. 1978, 76: 643-654. PubMed
UICC: TNM Classification of Malignant Tumours. 2002, New York: Wiley-Liss
Cancer Registry of Norway: Cancer in Norway 2008 - Cancer incidence, mortality, survival and prevalence in Norway. 2009, Oslo: Cancer Registry of Norway
Choi J, Kim SG, Kim JS, Jung HC, Song IS: Comparison of endoscopic ultrasonography (EUS), positron emission tomography (PET), and computed tomography (CT) in the preoperative locoregional staging of resectable esophageal cancer. Surg Endosc. 2010, 24: 1380-1386. 10.1007/s00464-009-0783-x. CrossRefPubMed
Westerterp M, van Westreenen HL, Sloof GW, Plukker JT, van Lanschot JJ: Role of positron emission tomography in the (re-)staging of oesophageal cancer. Scand J Gastroenterol. 2006, 243: 116-122. CrossRef
Heeren PA, Jager PL, Bongaerts F, van Dekken H, Sluiter W, Plukker JT: Detection of distant metastases in esophageal cancer with (18)F-FDG PET. J Nucl Med. 2004, 45: 980-987. PubMed
- Long-term survival from adenocarcinoma of the esophagus after transthoracic and transhiatal esophagectomy
Kjell K Ovrebo
Stein A Lie
Ole D Laerum
- BioMed Central
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