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Eur J Cardiothorac Surg 2007;31:536-544. doi:10.1016/j.ejcts.2006.12.002
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

An audit of surgical outcomes of esophageal squamous cell carcinoma

^a Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
^b Department of Surgery, National Yang-Ming University, Taipei, Taiwan, ROC
^c Department of Healthcare Administration, Tajen University, Pingtung, Taiwan, ROC
^d Intensive Care Unit of Department of Surgery, Kaohsiung Veterans General Hospital, Taiwan, ROC

Received 7 September 2006; received in revised form 30 November 2006; accepted 4 December 2006.

^_* Corresponding author. Address: Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan 813, ROC. Tel.: +886 7 342 2121x3044; fax: +886 7 3477618. (Email: goan{at}seed.net.tw).

Objective: Esophageal squamous cell carcinoma and adenocarcinoma were increasingly recognized as two entities with different biologic behaviors and prognosis. Surgical risks and oncologic benefits of transthoracic and transhiatal esophagectomy for esophageal squamous cell carcinoma patients are not confessed. Methods: Between 1994 and 2005, 216 esophageal squamous cell carcinoma patients underwent esophagectomy were enrolled and analyzed retrospectively. Results: One hundred sixty-six patients underwent transthoracic esophagectomy and 50 patients underwent transhiatal esophagectomy. The overall hospital mortality and postoperative complication rates were 9.7 and 49%, respectively. The amount of intra-operative blood loss or transfusion, postoperative complication rate, lengths of hospital stay and hospital mortality rate were not significantly different between both groups. However, shorter operative time was noticed in transhiatal group (p < 0.001). The overall 5-year survival rate was 16.8%. ESCC patients underwent either transthoracic or transhiatal esophagectomy had comparable long-term survival. The pTNM stage was independent prognostic factor for patients underwent transthoracic esophagectomy. However, location of tumor (p = 0.009) and pathologic tumor length (p = 0.012) were predictors of prognosis for patients underwent transhiatal esophagectomy. Conclusions: For esophageal squamous cell carcinoma patients, no significant differences in postoperative mortality or morbidity rates were observed between transthoracic and transhiatal esophagectomy. However, traditional pTNM staging system might underestimate the severity of esophageal squamous cell carcinoma patients who underwent transhiatal esophagectomy. The information of dissimilar prognostic factors for transhiatal or transthoracic esophagectomies will be helpful in tailoring more individualized adjuvant therapy to optimize esophageal squamous cell carcinoma patient's outcome.

Key Words: Esophagus • Squamous cell carcinoma • Esophagectomy • Prognostic factors

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