Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NHS Hospitals, Newcastle-upon-Tyne, UK.
School of Medical Education, Newcastle University, Newcastle-upon-Tyne, UK.
Ann Surg Oncol. 2021 Jun;28(6):3011-3022. doi: 10.1245/s10434-020-09200-3. Epub 2020 Oct 18.
Esophageal cancer has seen a considerable change in management and outcomes over the last 30 years. Historically, the overall prognosis has been regarded as poor; however, the use of multimodal treatment and the integration of enhanced recovery pathways have improved short- and long-term outcomes.
The aim of this study was to evaluate the changing trends in presentation, management, and outcomes for patients undergoing surgical treatment for esophageal cancer over 30 years from a single-center, high-volume unit in the UK.
Data from consecutive patients undergoing esophagectomy for cancer (adenocarcinoma or squamous cell carcinoma) between 1989 and 2018 from a single-center, high-volume unit were reviewed. Presentation method, management strategies, and outcomes were evaluated. Patients were grouped into successive 5-year cohorts for comparison and evaluation of changing trends.
Between 1989 and 2018, 1486 patients underwent esophagectomy for cancer. Median age was 65 years (interquartile range [IQR] 59-71) and 1105 (75%) patients were male. Adenocarcinoma constituted 1105 (75%) patients, and overall median survival was 29 months (IQR 15-68). Patient presentation changed, with epigastric discomfort now the most common presentation (70%). An improvement in mortality from 5 to 2% (p < 0.001) was seen over the time period, and overall survival improved from 22 to 56 months (p < 0.001); however, morbidity increased from 54 to 68% (p = 0.004).
Long-term outcomes have significantly improved over the 30-year study period. In addition, mortality and length of stay have improved despite an increase in complications. The reasons for this are multifactorial and include the use of perioperative chemo(radio)therapy, the introduction of an enhanced recovery pathway, and improved patient selection.
在过去的 30 年中，食管癌的治疗和预后发生了重大变化。历史上，整体预后一直被认为较差；然而，多模式治疗的应用和强化康复途径的整合改善了短期和长期预后。
本研究旨在评估英国一家高容量中心 30 多年来接受手术治疗食管癌患者的表现、治疗方法和结局的变化趋势。
回顾了 1989 年至 2018 年间在一家高容量中心连续接受食管癌（腺癌或鳞状细胞癌）切除术的患者数据。评估了患者的就诊方式、治疗策略和结局。患者被分为连续的 5 年队列进行比较和趋势评估。
1989 年至 2018 年间，1486 例患者接受了食管癌切除术。中位年龄为 65 岁（四分位距 [IQR] 59-71），1105 例（75%）为男性。腺癌占 1105 例（75%），总体中位生存期为 29 个月（IQR 15-68）。患者就诊方式发生了变化，现在上腹痛是最常见的表现（70%）。在此期间，死亡率从 5%降至 2%（p<0.001），总生存率从 22 个月提高到 56 个月（p<0.001）；然而，发病率从 54%增加到 68%（p=0.004）。
在 30 年的研究期间，长期预后有了显著改善。此外，尽管并发症增加，但死亡率和住院时间都有所改善。原因是多方面的，包括围手术期化疗（放疗）的应用、强化康复途径的引入以及患者选择的改善。
