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European Journal of Cardio-Thoracic Surgery, Vol 10, 359-363, Copyright © 1996 by European Association for Cardio-thoracic Surgery
DA Sharpe and K Moghissi
OBJECTIVE: Our objectives were to determine factors which influence
survival after resectional surgery in patients with cancer of the
oesophagus and cardia. PATIENTS AND METHOD: 562 consecutive patients with
primary cancer of the oesophagus or gastric cardia (oesophago- gastric
junction) undergoing resectional surgery and reconstruction of the
oesophagus 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 within
the oesophagus was: cervical (n = 32), upper thoracic (n = 18), middle
thoracic (n = 241) and lower thoracic and gastric cardia (n = 271). Of the
tumours 16% were stage I, 10% stage II and 74% stage III. Hospital
mortality rate was 9% overall, significantly higher in cervical tumours
(cervical tumours versus lower and or middle oesophageal tumours: P <
0.05), the elderly (age > 75 years versus age < 75 years: P <
0.05) and stage III disease (stage III versus stage I: P < 0.001). The
overall 5-year survival rate was 18%. There was no correlation between
tumour 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% for
stage II and 6% for stage III. The only significant correlation was between
the stage of disease and long- term survival (stage I versus stage III P
< 0.001, stage I versus stage II P < 0.05). CONCLUSIONS: Immediate
results are affected by a number of factors but long-term survival is
related entirely to the stage of the tumour.
ARTICLES
Resectional surgery in carcinoma of the oesophagus and cardia: what influences long-term survival?
Humberside Cardiothoracic Centre, Castle Hill Hospital, Cottingham, UK.
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