Improvement in the Prognosis of Esophageal Cancer Patients Treated by Surgery Alone (the Sweet Approach) in a High Volume Center Between 1970 and 2008 - A Retrospective Analysis of 5349 Cases

Abstract

Backgrounds: Worldwide the largest number of esophageal cancer surgery is performed in China and left thoractomy with limited lymphadenectomy (the Sweet approach) used to be the main surgical procedure before 2010. However the prognosis associated with this procedure had improved or not remains unanswered, duo to frequent lost to follow-up of patients operated since 1990. Methods: Using data of 5349 patients treated by surgery alone (Sweet) in a high volume center in 26 years (for which lost to follow-up <10%), we analyzed 5-year survival rates according to 1970-1979, 1980-1989, 1990-1994, and 2008 in relation to clinicopathological characteristics and technique development.Results: Both the rate of postoperative complication and of 3-month mortality decreased significantly (11.4%, 9.7%, 8.9% , 5.2%, P<0.01; 6.0%, 5.4%, 3.3%, 3.1%, P<0.05), but the death rate of surgical complications remained unchanged (52.9%, 55.2%, 56.9% , 59.4%, P>0.38). The proportion of patients without lymph node metastasis increased significantly ( 30.9%, 31.0%, 35.5% to 52.9%, P<0.001). The 5-year survival rate increased significantly (32%, 35%, 38%, 43%, P<0.000) albeit a limited number of lymph node retrieved (median: 4.0, 4.0, 4.0, 5.0, P >0.18 ). Multivariate Cox regression analysis identified pTNM stage (P<0.001), postoperative complications (P<0.001), lymph node metastasis (P<0.001), surgery year (P P<0.01), and age (P<0.05) as independent significant prognostic factors.Conclusion: The prognosis of esophageal carcinoma patients treated by surgery alone (Sweet approach) had improved from 1970-2008. Our data suggests that this improvement is due mainly to early diagnosis and reduced postoperative complication by experienced hands at high volume centers.