Surgical results of upper thoracic esophageal carcinoma

Due to its anatomical location, carcinoma of the upper thoracic esophagus (i.e. below the thoracic inlet and above the carina) often results in early invasion of adjacent structures and precludes radical resection. The prognosis of carcinoma of the upper thoracic esophagus was considered worse than that of distal esophagus. There are few studies specifically addressing the prognostic factors in the surgical treatment for carcinoma in this location. Herein we report a retrospective study conducted to analyze the result of surgical treatment for carcinoma of the upper thoracic esophagus.

From January 1983 to December 2002, 298 cases were diagnosed with upper thoracic esophageal carcinoma in our institute. Among them, 78 cases underwent operation with curative intent and were enrolled for study.

The tumors were stage I in 7.7%, stage II in 42.3%, stage III in 33.3% and stage IV in 12.8%. The postoperative morbidity and mortality rates were 59.0% and 6.8%, respectively. Pulmonary complication was the most common morbidity and also the leading cause of postoperative death. The overall median survival time after surgery was 13.1 months. The 1-, 3- and 5-year survival rates were 53.9%, 28.7% and 21.4%, respectively. There was an improvement in surgical result over time. The 5-year survival rate improved from 13.6% in the earlier 10-year period to 37.6% in the latter 10-year period (p = 0.0493). Univariate analysis revealed 5 positive prognostic factors: tumor length (p = 0.0012), pT status (p = 0.0274), pN status (p = 0.001), pathologic stage (p = 0.0322) and R category (p = 0.0009). Multivariate analysis identified pN status, R category and tumor length as independent prognostic indicators. In patients receiving neoadjuvant therapy, the 5-year survival rate after surgery was 23.4%, which was similar to those undergoing surgery alone (p = 0.5174). For patients with advanced tumor stages (ie. pT > 3, pN > 0, pM > 0) or with residual tumors (R1/2 resection), the 5-year survival rates were significantly different in patients with and without postoperative adjuvant chemoradiation therapy (16.0% vs. 0%, p = 0.0045). CONCLUSIONS; For carcinomas in the upper thoracic esophagus, the prognosis was dismal. Surgical resection remains the treatment of choice. In addition to lower resectability, the postoperative morbidity and mortality rates were relatively high. The length of tumor extension, status of lymph node involvement and radicality of surgery were independent prognostic factors.