The Recurrence and Survival after Complete Resection of Esophageal Cancer

Kim, Hyoung Soo; Yoo, Jeong Woo; Kim, Kwhanmien; Shim, Young Mog

Abstract

BACKGROUND: Esophageal cancer is an aggressive disease with a poor prognosis. Recently, neoadjuvant therapy has been used in an attempt to increase the long term survival but has not been shown as a clear advantage. We reviewed the recurrence and survival after complete resection of esophageal cancer without neoadjuvant therapy. MATERIAL AND METHOD: From December 1994 to December 2001, 182 consecutive patients who underwent intrathoracic esophagectomy, transthoracic esophagogastrostomy and two-field lymph node dissection for esophageal cancer without neoadjuvant therapy were studied retrospectively. RESULT: There were 167 men and 15 women. The median age was 65 years (range, 40 to 90 years). The tumor was located in the upper third part of the esophagus in 7 patients (3.8%), middle third in 86 (47.3%), and lower third in 89 (48.9%). The postsurgical stage were as follows: stage 0 in 2 patients (1.1%), stage I in 32 (17.6%), stage IIA in 47 (25.8%), stage IIB in 25 (13.7%), stage III in 54 (29.7%), stage IVA in 10 (5.5%), and stage IVB in 12 (6.6%). The in-hospital mortality rate was 3.8% (7 patients) and complications occurred in 65 patients (35%). Follow-up was complete in 95.6%. The recurrence occurred in 56 patients (30.8%) and the overall 5-year disease free rate was 55%. The overall 5-year survival rate was 57%; it was 80% for patients in stage I, 65% in stage IIA, 58% in stage IIB, 48% in stage III, and 40% in stage IVB. The overall 5-year survival rate of patients with postoperative adjuvant therapy was 59% compared to 34% in patients without postoperative adjuvant therapy (p <0.05).
CONCLUSION
The most effective therapy for esophageal cancer may be complete resection. More aggressive surgical therapy and adjuvant therapy may improve the long-term survival, even for advanced stage esophageal cancer.