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Improved Long-Term Survival After Esophagectomy for Esophageal Cancer: Influence of Epidemiologic Shift and Neoadjuvant Therapy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The study was done to determine long-term outcomes of surgically treated esophageal cancer and to identify trends in epidemiology, oncological therapy, and oncological prognosis over the last two decades.

Methods

Overall survival in 304 patients undergoing esophagectomy was analyzed. Fifty-three percent had squamous cell carcinoma and 46 % had adenocarcinoma (AC). A total of 161 patients received neoadjuvant chemoradiation, 38 received neoadjuvant chemotherapy, and 105 were treated with surgery alone.

Results

Median survival (MS) increased significantly from 18.0 months (1988–1994) to 26.6 months (1995–2001) and to 59.3 months (2002–2011; p < 0.001). The proportion of AC (22 vs 35 vs 65 %; p < 0.001) and the proportion of patients treated with neoadjuvant therapy (neoT; 15.9 vs 85.3 vs 77.8 %; p < 0.001) increased during the treatment period. After neoT, a beneficial outcome with a MS of 45.6 vs. 20.4 months (p = 0.003) was found. Lymph node ratio [LNR; relative risk (RR), 5.4; p < 0.001], response to neoT (RR, 1.6; p < 0.004), and histological subtype (RR, 1.7; p < 0.003) were identified as independent parameters of survival.

Conclusion

Since 1988, the outcome of surgically resected esophageal cancer strongly improved. Besides tumorbiological factors like histological type and LNR, the outcome is also affected by the increasing use of neoT towards favorable survival rates.

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany

    Frank Makowiec, Peter Baier, Birte Kulemann, Goran Marjanovic, Ulrich Theodor Hopt & Jens Hoeppner

  2. Department of Pathology, University of Freiburg, Freiburg, Germany

    Peter Bronsert

  3. Department of Radiation Oncology, University of Freiburg, Freiburg, Germany

    Michael Henke

  4. Department of Medicine, University of Freiburg, Freiburg, Germany

    Katja Zirlik

Authors
  1. Frank Makowiec
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  2. Peter Baier
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  3. Birte Kulemann
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  4. Goran Marjanovic
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  5. Peter Bronsert
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  6. Katja Zirlik
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  7. Michael Henke
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  8. Ulrich Theodor Hopt
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  9. Jens Hoeppner
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Corresponding author

Correspondence to Jens Hoeppner.

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Makowiec, F., Baier, P., Kulemann, B. et al. Improved Long-Term Survival After Esophagectomy for Esophageal Cancer: Influence of Epidemiologic Shift and Neoadjuvant Therapy. J Gastrointest Surg 17, 1193–1201 (2013). https://doi.org/10.1007/s11605-013-2212-7

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  • DOI: https://doi.org/10.1007/s11605-013-2212-7

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