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Ann Thorac Surg 1998;65:1492-1493
© 1998 The Society of Thoracic Surgeons
a Section of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
Address reprint requests to Dr Mansour, The Emory Clinic, 1365 Clifton Rd, NE, Atlanta, GA 30322
In 1989, we reported our experience with surgical resection as primary therapy for esophageal carcinoma [1]. This cohort included 100 consecutive patients (group 1) treated from 1967 to 1987. Over the past 10 years, we have used surgical resection as primary therapy in an additional 137 patients with esophageal carcinoma (group 2). A recent retrospective chart review was undertaken to obtain follow-up and mean survival of the 100 original patients since the original report and of the 137 new patients. Follow-up was obtained using chart reviews, telephone interviews, and the oncology data bank. Follow-up was complete for all patients.
Twenty-two patients with stage 1 esophageal carcinoma (6 in group 1 and 16 in group 2) underwent esophageal resection without preoperative chemotherapy. The 6 patients in group 1 (the original group) were apparently cured from esophageal cancer. Disease-free survival for these 6 patients was 182 months (range, 124 to 231 months). Of the 6 patients, 2 died of disease processes not related to cancer, and 4 patients remain alive without evidence of recurrent cancer. The duration of follow-up was 124 to 231 months. Subsequently, 16 additional patients with stage I esophageal cancer underwent operation from 1987 to 1997. Disease-free survival for these 16 patients was 50 months (range, 9 to 132 months). Of these 16 patients, 2 died of diseases not related to cancer, whereas the remaining 14 remain alive without evidence of recurrent cancer. Follow-up for these 16 patients was 9 to 132 months. Disease-free survival for both group 1 and group 2 patients combined, with stage I esophageal cancer, was 86 months (range, 9 to 231 months).
Esophagectomy was performed in 51 patients with stage II esophageal carcinoma (14 in group 1 and 37 in group 2). Fourteen patients with stage II esophageal carcinoma from the original group (group 1) were apparently free from cancer for a mean duration of 14 months (range, 2 to 42 months), and their mean survival was 25 months (range, 3 to 52 months). At the time of the original report, 3 of the 14 patients were alive. However, all 3 patients died as a result of recurrence within 24 months after surgical resection. Mean follow-up for these patients was 3 to 52 months. Thirty-seven patients in group 2 with stage II esophageal carcinoma were apparently free from cancer recurrence for a mean duration of 17 months (range, 2 to 70 months), and their mean survival was 27 months (range, 5 to 76 months). Of the 37 patients in group 2, 24 patients died of cancer recurrence and 8 died of a medical condition not related to cancer. The remaining 5 patients are alive after surgical resection for a mean of 13 months (range, 8 to 21 months). Mean follow-up for the 37 patients in group 2 is 5 to 61 months. Fifty-one patients (groups 1 and 2 combined) with stage II esophageal cancer were free from cancer for a mean of 16 months (range, 2 to 70 months), and their mean survival was 26 months (range, 3 to 76 months).
One-hundred sixty-four patients underwent operation for stage III esophageal cancer (80 in group 1 and 84 in group 2). Eighty patients in group 1 with stage III esophageal carcinoma were free from cancer for a mean duration of 10 months (range, 2 to 21 months), and their mean survival was 18 months (range, 1 to 28 months). In the original report, only 1 patient with stage III esophageal carcinoma was alive. This patient died as a result of recurrence within 20 months after surgical resection. Similarly, 84 patients with stage III carcinoma in group 2 were free from cancer for a mean duration of 11 months (range, 1 to 26 months), and their mean survival was 21 months (range, 1 to 30 months). Of the 84 patients in group 2, 74 patients died of cancer recurrence and 6 patients had cancer recurrence, but died with a medical diagnosis not related to cancer. The remaining 4 patients are alive after surgical resection for a mean of 4 months (range, 2 to 7 months), and all 4 have cancer recurrence. One-hundred sixty-four patients (groups 1 and 2 combined) with stage III esophageal cancer were free from carcinoma for 11 months (range, 1 to 26 months), and their mean survival was 20 months (range, 1 to 30 months).
Survival of patients with esophageal carcinoma remains primarily related to local extent of disease and nodal involvement [2]. Prospective, randomized trials using various combined treatment modalities have failed to show a significant improvement in survival [3–5]. Response rates have been variable, and toxicity and disease progression during neoadjuvant therapy remain significant problems [4].
We have continued to offer surgical resection as primary therapy to all patients in stages I and II. Patients in stage III without extensive mediastinal involvement remain challenging. Those with bulky stage III disease are given neoadjuvant therapy in an attempt to downstage the disease before an attempt at definitive surgical resection. We feel strongly that aggressive surgical intervention remains the cornerstone of treatment for esophageal carcinoma. Therefore, we have continued this approach over the intervening 10-year period.
Footnotes
As Originally Published in 1989:
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References
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