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Ann Thorac Surg 2004;78:1177-1183
© 2004 The Society of Thoracic Surgeons
a Service de Chirurgie Digestive et Générale, Hôpital Claude Huriez, Lille, France
b Unité INSERM 560, Centre Hospitalier Régional Universitaire, Lille, France
Accepted for publication February 17, 2004.
* Address reprint requests to Dr Mariette, Service de Chirurgie Digestive et Générale, Hôpital Claude Huriez, CHRU, Place de Verdun 59037, Lille Cedex, France
c-mariette{at}chru-lille.fr
BACKGROUND: To identify factors affecting postoperative course and survival after esophagectomy for cancer and reasons for improved survival over time.
METHODS: Complete esophageal resection was attempted for middle and lower third esophageal carcinomas in 386 consecutive patients between January 1982 and January 2002. Two study periods were analyzed: 1982 to 1993 and 1994 to 2002. Prognostic factors were identified by multivariate analysis and the two periods compared.
RESULTS: Hospital mortality rate decreased from 5.4% to 2.9% (p = 0.245). Both anastomotic leakage and pulmonary complications rates decreased from 9.8% to 2.2% (p = 0.001) and 24.1% to 19.3% (p = 0.295), respectively. An increased proportion of patients had R0 resection in the latter period, 78.5% versus 67.0%, (p = 0.028). Five-year survival rate after R0 resection increased from 29% to 46% (p = 0.001), with a decreased recurrence rate from 65.8% to 44.3% (p = 0.002). Three favorable prognostic factors were identified: low pT stage, pN0 stage, and operation during the 1994 to 2002 study period.
CONCLUSIONS: Short-term outcome and survival of patients with resected esophageal cancer have improved over time. Advances in perioperative technique, staging methods, and surgical management combined with higher patient selection and use of neoadjuvant chemoradiation may be responsible for this progress.
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