Ruol Alberto, Castoro Carlo, Portale Giuseppe, Cavallin Francesco, Sileni Vanna Chiarion, Cagol Matteo, Alfieri Rita, Corti Luigi, Boso Caterina, Zaninotto Giovanni, Peracchia Alberto, Ancona Ermanno
Department of Gastrointestinal and Surgical Sciences, Clinica Chirurgica III, University of Padova School of Medicine, Via Giustiniani 2, 35128 Padova, Italy.
Arch Surg. 2009 Mar;144(3):247-54; discussion 254. doi: 10.1001/archsurg.2008.574.
To investigate trends in results of esophagectomies to treat esophageal cancer at a single high-volume institution during the past 25 years.
Retrospective cohort study in a university tertiary referral center.
Patients with cancer of the thoracic esophagus or esophagogastric junction seen from 1980 through 2004 were included (N = 3493). Three time periods were defined: 1980-1987, 1988-1995, and 1996-2004.
Clinical presentation, tumor characteristics, and morbidity, mortality, and survival rates among patients with esophageal cancer undergoing esophagectomy.
The ratio of squamous cell carcinoma to adenocarcinoma decreased from 3.3 to 1.7 (P <.001) during the study period, in parallel with an increase in the number of patients with tumors in the lower esophagus/esophagogastric junction. An increasing proportion of patients who underwent resection received neoadjuvant treatment (chemotherapy/chemoradiotherapy), and 1978 patients underwent esophagectomy. The R0 resection rate increased from 74.5% to 90.1% (P <.001). In addition, an increasing proportion of patients had early-stage tumor in the resected specimen. In-hospital postoperative mortality decreased from 8.2% to 2.6% (P <.001), and the 5-year survival rate significantly improved from 18.8% to 42.3% (P <.001) for all patients who underwent resection. Pathological tumor stage, completeness of the resection, time period, sex, tumor histological type, and tumor location influenced the prognosis of patients with esophageal cancer undergoing esophagectomy.
A change in location and histological type of esophageal cancer has occurred during the past 25 years. Earlier diagnosis, a multidisciplinary approach, and refinements in surgical technique and perioperative care have led to a significant reduction in postoperative mortality rate and improved long-term survival among patients with cancer of the thoracic esophagus or esophagogastric junction.
调查过去25年里，在一家高容量机构中，食管癌食管切除术的治疗结果趋势。
在一所大学三级转诊中心进行的回顾性队列研究。
纳入1980年至2004年间就诊的胸段食管癌或食管胃交界部癌患者（N = 3493）。定义了三个时间段：1980 - 1987年、1988 - 1995年和1996 - 2004年。
接受食管切除术的食管癌患者的临床表现、肿瘤特征以及发病率、死亡率和生存率。
在研究期间，鳞状细胞癌与腺癌的比例从3.3降至1.7（P <.001），同时食管下段/食管胃交界部肿瘤患者数量增加。接受切除术的患者中，接受新辅助治疗（化疗/放化疗）的比例不断上升，1978例患者接受了食管切除术。R0切除率从74.5%提高到90.1%（P <.001）。此外，切除标本中早期肿瘤患者的比例不断增加。所有接受切除术的患者术后住院死亡率从8.2%降至2.6%（P <.001），5年生存率从18.8%显著提高到42.3%（P <.001）。病理肿瘤分期、切除完整性、时间段、性别、肿瘤组织学类型和肿瘤位置影响接受食管切除术的食管癌患者的预后。
在过去25年里，食管癌的位置和组织学类型发生了变化。早期诊断、多学科方法以及手术技术和围手术期护理的改进，已使胸段食管癌或食管胃交界部癌患者的术后死亡率显著降低，并改善了长期生存率。
