The Result of Surgical Treatment for Esophageal Cancer

Kim, Jeong Wook; Kim, Choong Bai; Min, Jin Sik

Abstract

This study is to evaluate the clinicopathologic characteristics of esophageal cancer and to assess its surgical outcome according to these clinicopathologic features. A retrospective analysis was performed for 90 esophageal cancer patients who had undergone a radical esophagectomy or a palliative operation by the one surgeon at the Department of Surgery, Yonsei University, College of Medicine, from Jan. 1990 to Aug. 1996. The survival rates were calculated by the Kaplan-Meier method. The middle one-third of the esophagus was the most frequent site with 48 cases. T3 depth of invasion was present in 53 cases (57%) at the time of operation and a superficial depth in 18 cases (20%). The rates of lymph-node metastasis was 25% in T1; 47% in T2; 66% in T3 or more. 40 patients were in stage I, 23 in IIa, 13 in IIb, 33 in III, and 7 in IV. A transhiatal esophagectomy(THE) was performed in 28 cases, and a 3-staged radical esophagectomy (transthoracic radical esophagectomy; TTRE) was done in 56 cases. The most common early postoperative complication was hoarseness, but it disappeared within 6 months. The commonly noted late complication was esophageal stricture, and it was corrected by Savary-Guillard dilatation. The leading cause of death during the follow-up period was recurrence; it was about 30 cases(33%). The survival rates according to lymph-node metastasis were 50.1% for lymph-node negative cases and 16.3% for, lymph-node positive cases. The survival rates according to depth of invasion were 83.3% in mucosa confined cases, 46.7% in submucosa invasion cases, 30.3% in muscularis propria invasion cases, and 36.5% in adventitia invasion cases. The five-year survival rates according to stage were 56.4% in stage I, 51% in stage IIa, 48% in IIb, and 33.1% in III. From this study, it can be concluded that the frequent numbers of early esophageal lesions in our study may have been a major factor in the relatively high survival rate; also the low operative mortality rate encourages us to use surgical resection for the treatment of esophageal cancer.