Introduction The surgical management and clinical outcome of esophageal cancer continue to improve with advances in surgical techniques and better perioperative care. We reviewed our experience with esophagectomies for esophageal cancer from 1970-2005. Trends in surgical outcomes and specific postoperative morbidities were evaluated over this 35-year period.
Methods A retrospective study was conducted of the hospital records of all patients who underwent esophagectomies for esophageal cancer (including the gastroesophageal junction) at the University of California Los Angeles Medical Center between January 1, 1970 and September 1, 2005. Three groups of patients were evaluated: remote, past and present: operated between 1970 and 1983 (n = 111), 1984 and 1993 (n = 205), and 1994 and present (n = 151), respectively. Our main perioperative outcome measures were operative mortality, cardiac arrhythmia, renal failure, pulmonary complication, anastomotic leaks, and reoperations.
Results There were 467 patients, 354 male, 113 female. Two hundred forty-seven underwent transthoracic esophagectomy and 177 underwent transhiatal esophagectomy, 9 underwent a transabdominal resection, 18 underwent palliative bypass surgery, and 16 had an open and close surgery. Four hundred thirty-two had an esophagectomy with a gastric pull-up and two had colon interpositions. Six were done laparoscopically and two were robot-assisted. When the remote, past, and present groups were compared, we noted the following: operative mortality was 10%, 3%, 4%, respectively; the rate of re-operation was 20%, 8%, 9%, respectively; anastomotic leaks were noted in 12%, 5%, and 2% of patients, respectively; pulmonary complications were noted in 50%, 34%,19% of patients, respectively; cardiac complications were noted in 31%, 18%, 15% of patients, respectively; and renal complications were noted in 6%, 2%, 3%, respectively.
Conclusions Surgical outcomes of patients undergoing an esophagectomy for cancer have changed over the past 35 years. Significant improvements have been made with respect to pulmonary complications and anastomotic leaks. Further studies need to be done to determine the factors that have contributed to the trends observed in this study.
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