Autopsy findings in patients with esophageal carcinoma: comparison between resection and nonresection groups

The prognosis of patients with esophageal cancer is poor, despite attempts at aggressive multimodality treatment. To yield some important information that could help to improve operative methods and multimodality treatments, we compared autopsy findings such as the extent of local and metastatic spread of cancer in resection (n = 33) and nonresection (n = 38) groups of patients who had had esophageal cancer. Residual or recurrent esophageal cancer was identifiable in 71.9% of patients in the resection group and 94.4% of patients in the nonresection group. Local residual cancer was identified much less frequently in the former group than in the latter (21.2% vs. 94.4%) (P < 0.0001). The most frequent mode of metastasis was hematogenous, occurring in 51.5% of the resection cases and 63.9% of the nonresection cases. Lymph-node metastasis was also observed frequently, being present in 51.5% of resection cases and 58.3% of nonresection cases. Serosal dissemination of cancer was found in 36.4% of resection cases and 25.0% of nonresection cases. The low incidence of localized disease suggests that esophagectomy, even though palliative in some cases, is effective as a treatment for esophageal cancer. The high incidence of lymph-node and hematogenous metastasis after esophagectomy implies that more extensive lymph-node dissection and stronger adjuvant chemotherapy might be required.