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ObjectiveTo document the clinicopathologic characteristics and survival of patients undergoing esophagectomy for squamous carcinoma of the thoracic esophagus, and to examine the factors contributing to improvements in outcome noted in patients with advanced carcinoma. Summary Background DataJapanese and some Western surgeons recently have reported that radical esophagectomy with extensive lymphadenectomy conferred a survival advantage to patients with esophageal carcinoma. The factors contributing to this improvement in results have not been well defined. MethodsFrom 1981 to 1995, 419 patients with carcinoma of the thoracic esophagus underwent esophagectomy at the Keio University Hospital. The clinicopathologic characteristics and survival of patients treated between 1981 and 1987 were compared with those of patients treated between 1988 and 1995. Multivariate analysis using the Cox regression model was carried out to evaluate the impact of 15 variables on survival of patients with p stage IIa to IV disease. Several variables related to prognosis were examined to identify differences between the two time periods. ResultsThe 5-year survival rate for all patients was 40.0%. The 5-year survival rate was 17.7% for p stage IIa to IV patients treated during the earlier period and 37.6% for those treated during the latter period. The Cox regression model revealed seven variables to be important prognostic factors. Of these seven, three (severity of postoperative complications, degree of residual tumor, and number of dissected mediastinal nodes) were found to be significantly different between the earlier and latter periods. ConclusionsThe survival of patients undergoing surgery for advanced carcinoma (p stage IIa to IV) of the thoracic esophagus has improved during the past 15 years. The authors' data suggest that this improvement is due mainly to advances in surgical technique and perioperative management.In Japan, surgeons have the primary responsibility for treating patients with carcinoma of the thoracic esophagus. In the past two decades, advances in esophageal cancer surgery have been remarkable. These advances have included more accurate diagnostic and staging techniques, performance of radical esophagectomy with extensive lymphadenectomy, appropriate use of limited surgery, and improvements in perioperative management and adjuvant therapy. Consequently, a 5-year survival rate of more than 50% 1 has been reported in patients who underwent threefield dissection. The aim of our study was to analyze the management and outcome of patients with carcinoma of the thoracic esophagus who underwent esophagectomy during a recent 15-year period to identify the factors contributing to the improvement in the management of this tumor.

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MIE was comparable with conventional OE in terms of short-term outcome after esophagectomy. It was particularly beneficial in reducing postoperative respiratory complications, but may be associated with higher reoperation rates.

These results indicate that postoperative infectious complications may worsen patient prognosis after esophagectomy. Performing esophagectomy without postoperative complications, especially pneumonia, may be beneficial for improving survival outcomes.