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*ACTUAL 5‐YEAR SURVIVORS FOLLOWING OESOPHAGECTOMY AND PREDICTORS OF SURVIVAL
Author(s) -
Hirst J.,
Smithers M.,
Gotley D.,
Martin I.,
Thomas J.,
Barbour A.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04920_12.x
Subject(s) - odynophagia , medicine , dysphagia , stage (stratigraphy) , esophagectomy , survivorship curve , surgery , cancer , chemoradiotherapy , esophageal cancer , multivariate analysis , radiation therapy , paleontology , biology
Purpose: Oesophagectomy remains the mainstay of curative treatment for localised oesophageal cancer. Despite this there is a paucity of data reporting actual 5 year survivors following oesophagectomy. This study was undertaken to identify and characterise actual 5 year survivors who underwent oesophagectomy. Methods: A prospectively maintained database identified 526 patients who underwent oesophagectomy from 1987 to 2008. Patients were followed for a minimum of 5 years or until death. Clinico‐pathologic factors associated with 5 year disease‐specific survivorship were analysed. Median follow‐up for all patients was 40 months. Results: Median disease specific survival (DSS) was 32 months. Neoadjuvant therapy was administered to 248/526 (47%). There were 95/526 (18%) actual 5‐year survivors. On multivariate analysis, 5‐year survivors were significantly lower T stage, N stage and less likely to have received blood transfusion compared with patients who died less than 5 years after surgery. There were 76/526 (14%) patients with positive margins and of these 6 patients were 5 year survivors. Amongst 5‐year survivors, 41 (43%) had neoadjuvant therapy. Of the 95 5‐year survivors, 14 (14%) subsequently died of oesophageal cancer. The prognostic factors for DSS after 5 years were dysphagia or odynophagia at presentation. Stage was no longer a prognostic factor after surviving to 5 years. Conclusion: No single clinico‐pathological variable negated survival to 5 years. Prognostication in 5 year survivors is difficult, but odynophagia and dysphagia at presentation are still active as prognostic factors after 5 years. The majority of 5‐year survivors can be considered cured of oesophageal cancer.