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OESOPHAGEAL CANCER: OUTCOME OF MODERN SURGICAL MANAGEMENT
Author(s) -
O'Rourke I.,
Tait N.,
Bull C.,
Gebski V.,
Holland M.,
Johnson D. C.
Publication year - 1995
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1995.tb01739.x
Subject(s) - medicine , surgery , stage (stratigraphy) , swallowing , esophagectomy , cancer , survival rate , prospective cohort study , carcinoma , esophageal cancer , general surgery , paleontology , biology
Many clinicians still associate oesophagectomy for oesophageal carcinoma with low cure rates, poor palliation and prohibitive peri‐operative mortality. Surgical advances have rendered such perceptions inaccurate. A prospective study of all patients undergoing surgery for oesophageal cancer in an Australian teaching hospital between 1979 and 1993 has been undertaken. Selection. staging, pre‐operative preparation, surgical technique and postoperative care were all carefully controlled. One hundred and thirty‐seven patients were explored. Twenty‐one were inoperable. One hundred and sixteen underwent resection with intent to cure. Hospital mortality for oesophagectomy was 1.7%. There were no cases of clinical anastomotic leakage. Eighty‐nine per cent achieved excellent to good swallowing. The median survival for all cases was 14 months and the 5 year survival was 18%. Median survival for resected cases was 18 months and the 5 year survival was 26%. The long‐term survival was related to postoperative stage of the disease but not to tumour type. Oesophagectomy for oesophageal cancer will restore good swallowing in 90% of cases. Operative mortality should be less than 5% and the overall 5 year survival 20–3096. Early tumours can often be cured ( ca in situ 100%. stages I and II 50–60%), indicating the benefits of early detection. Poor survival in advanced disease (stage III 15%. stage IV 0%) on a background of low surgical mortality indicate the need for better staging and more effective adjuvant therapies.