Resectional surgery in carcinoma of the oesophagus and cardia: what influences long-term survival?

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Abstract
OBJECTIVE: Our objectives were to determine factors which influencesurvival after resectional surgery in patients with cancer of theoesophagus and cardia. PATIENTS AND METHOD: 562 consecutive patients withprimary cancer of the oesophagus or gastric cardia (oesophago- gastricjunction) undergoing resectional surgery and reconstruction of theoesophagus were studied. Operative approach depended on tumour location,the aim being complete resection of the tumour and associated lymph nodes.Postoperative staging was based on tumour, nodes and metastasis (TNM)classification. RESULTS: There were 342 males and 220 females, aged 61.8+/- 12.8 years. Histology of the tumours was: squamous cell carcinoma 49%,adenocarcinoma 47.5% and other tumours 3.5%. The location of tumours withinthe oesophagus was: cervical (n = 32), upper thoracic (n = 18), middlethoracic (n = 241) and lower thoracic and gastric cardia (n = 271). Of thetumours 16% were stage I, 10% stage II and 74% stage III. Hospitalmortality rate was 9% overall, significantly higher in cervical tumours(cervical tumours versus lower and or middle oesophageal tumours: P 75 years versus age < 75 years: P <0.05) and stage III disease (stage III versus stage I: P < 0.001). Theoverall 5-year survival rate was 18%. There was no correlation betweentumour histology, location or type of operation and long-term survival.Survival disease-free for 5 years or more was 73% for stage I, 15.8% forstage II and 6% for stage III. The only significant correlation was betweenthe stage of disease and long- term survival (stage I versus stage III P< 0.001, stage I versus stage II P < 0.05). CONCLUSIONS: Immediateresults are affected by a number of factors but long-term survival isrelated entirely to the stage of the tumour.

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