Results of curative therapy for esophageal cancer in a community training hospital

A 12-year experience of therapy for esophageal carcinoma in a community-based cancer center was reviewed retrospectively. Of a total of 88 patients with histologically proven carcinoma of the esophagus 30 (34.1%) underwent curative esophagectomy. Twelve patients received preoperative chemoradiotherapy. Fourteen esophagectomies were performed transhiatally and 16 via the thoracolaparotomy approach. The average distance from incisors was 32.2 and 32.1 cm, respectively. Overall morbidity was 36.7%, with major complications in 30% of patients. Mortality was 3.3%. A comparison of patients treated with preoperative chemoradiotherapy (12 patients) and surgery alone (18 patients) showed no statistical difference in morbidity, mortality, or length of hospital stay. Analysis of these parameters in groups of patients operated via the transhiatal versus thoracolaparotomy approach demonstrated statistically lower morbidity (14.3% versus 56.3%, respectively), with no difference in mortality and a trend toward a shorter hospital stay in the former group. Overall survival at 3 years was 63.9%. In the combined therapy group, 90.9% of patients survived 3 years compared to 40.4% in the surgery only group (P = 0.0177). There was a trend toward better survival in the group of patients treated via the transhiatal approach. This study demonstrated that curative therapy for esophageal carcinoma can be performed with acceptable morbidity and mortality in a community teaching hospital.