Comparative Study of Predictive Mortality Scores in Esophagectomy with Three-Field Lymph Node Dissection in Patients with Esophageal Cancer

Abstract

Background/Aim: Esophagectomy is still the best therapeutic option for curing resectable esophageal cancer (EC). Radical surgical resection with three-field lymphadenectomy (3FLD) is a potentially curative treatment option. We compared the predictive accuracy of 5 different scores in patients with EC who underwent 3FLD. Methods: Five years’ worth of medical records in a single institution were analyzed (January 2010 to January 2015) from 311 patients who underwent esophagectomy for EC. We selected 191 in whom 3FLD was performed. Mortality was calculated based on 5 predictive scores. Outcomes measures were intraoperative mortality, 30-day mortality, and 1- and 2-year mortality after surgery. Results: Intraoperative mortality and 30-day mortality after surgery was 0%; 1 and 2-year mortality were 19.8 and 31.4%, respectively. The area under the curve showed poor discriminatory power for all 5 scores (<0.7). In one-way analysis of variance, for 1 year mortality, Portsmouth-Physiological and Operative Severity Score for mortality (P-Possum) was significant (p = 0.0424); in a multivariable analysis for 2-year mortality, P-Possum (p < 0.0001) remained significant. Conclusion: There is no accurate prognosis score for esophagectomy in patients who undergo high-risk procedures like 3FLD. New scores are needed to predict the mortality after 3FLD with good discriminatory power. Independent factors affect survival and may function as the baseline for obtaining a new accurate mortality score.

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“…In our patients with tumor-free margins, we practice periodic observation for at least 5 years to provide early control of recurrence. In cases of any local or distal recurrence, we prefer surgery (3FLD) as first line because it produces good results, and chemotherapy for patients who cannot receive surgical treatment or who have distant metastasis [6,14]. Risk factors for recurrence significantly associated with prognosis in our study were age (> 65 years), male gender, and positive vertical margin.…”

“…Advanced age was shown to be significantly associated with mortality in EC. Even after radical treatment, patients over age 65 have more risk with any type of medical procedure [14]. In elderly patients with significant comorbidities, high risk of general anesthesia, superficial tumor and small tumor size (< 2 cm), we prefer to perform EMR, mainly because it can be performed under sedation.…”

Mid- and long-term outcomes of endoscopic resection for submucosal esophageal cancer types pT1b-SM1 and pT1b-SM2

“…In our patients with tumor-free margins, we practice periodic observation for at least 5 years to provide early control of recurrence. In cases of any local or distal recurrence, we prefer surgery (3FLD) as first line because it produces good results, and chemotherapy for patients who cannot receive surgical treatment or who have distant metastasis 6 14 .…”

A randomized trial of negative pressure wound therapy technology combined with intermittent instillation in the treatment of neck anastomotic leakage after esophageal cancer surgery

“…Esophageal cancer is a common malignant tumor of the digestive tract in China (1). Currently, surgical resection is still the most effective radical treatment for esophageal cancer, especially early and mid-stage esophageal cancer (2). However, gastroesophageal anastomosis inevitably needs to be performed to reconstruct the digestive tract after removing the diseased esophagus.…”