ArticleDer Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen2015
[Surgical treatment of esophageal cancer : Evolution of management and prognosis over the last 3 decades].
Article in Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Article
- [Intrathoracic anastomotic leakage following esophageal and cardial resection : Definition and validation of a new severity grading classification].Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen · 2018Review
- Endoscopic esophagogastric anastomosis with luminal apposition Axios stent (LAS) approach: a new concept for hybrid "Lewis Santy".Endoscopy international open · 2017Article
- Hybrid minimally invasive esophagectomy vs. open esophagectomy: a matched case analysis in 120 patients.Langenbeck's archives of surgery · 2017Article
- Prognostic Significance of mTOR and PTEN in Patients with Esophageal Squamous Cell Carcinoma.BioMed research international · 2015Article
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Authors and funding
7 authors.
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Abstract
backgroundAn increasing incidence of adenocarcinoma, a modified surgical strategy and the increasing use of multimodal therapeutic protocols have had a major impact on the surgical treatment of esophageal cancer during the last 3 decades.
objectivesThis study analyzed the development of these factors and their impact on the short and long-term prognosis of esophageal cancer over the last 25 years. PATIENTS AND
methodsThe study included 366 patients with esophageal cancer treated by esophagectomy at the University Hospital in Freiburg from 1988 to 2012. The study period was split into four time periods for further comparisons, i.e. 1988-1994, 1995-2001, 2001-2006 and 2007-2012.
resultsWithin the time periods analyzed a marked increase in adenocarcinoma was found (time periods1988-1994, 1995-2001, 2001-2006 and 2007-2012: 21%, 37%, 61% and 64%, respectively, p<0.001). The initially commonly used transhiatal approach and reconstruction with cervical anastomosis was gradually replaced by the thoracoabdominal procedure with intrathoracic reconstruction (i.e. Ivor Lewis esophagectomy, 2007-2012: 98 %). During the study period increasingly more patients received multimodal therapy (13%, 85%, 72% and 84%, p<0.001), the overall rate of perioperative complications (70%, 88%, 73% and 56%, p<0.001) and perioperative mortality (16%, 18%, 8% and 2.5%, p<0.001) were significantly reduced, while the overall 5-year survival (12%, 34%, 41% and 62%, p<0.001) improved. An early tumor stage (p=0.002), N0 status (p<0.001) and histological type of adenocarcinoma (p=0.011) were identified as independent predictors of improved survival.
conclusionDuring the period from 1988 to 2012 a significant improvement of long-term survival as well as a marked reduction of perioperative mortality after esophagectomy were observed. The improved outcome was associated with an increased use of multimodal therapeutic protocols, the preferred use of thoracoabdominal esophagectomy and epidemiological changes in histology over the study period.
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