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Advanced esophageal carcinoma

T E Lerut1, P de Leyn, W Coosemans

  • 1Department of Surgery, Catholic University Leuven, Belgium.

World Journal of Surgery
|May 1, 1994
PubMed
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Complete surgical resection significantly improves survival for patients with advanced esophageal squamous cell carcinoma, especially when lymph nodes are negative. Incomplete resection drastically reduces survival rates.

Area of Science:

  • Oncology
  • Surgical Oncology
  • Gastrointestinal Surgery

Background:

  • Esophageal squamous cell carcinoma (ESCC) presents a significant challenge in surgical oncology.
  • Patient outcomes are heavily influenced by tumor stage and lymph node involvement.
  • Accurate staging and complete tumor resection are critical for improving survival.

Purpose of the Study:

  • To evaluate the impact of surgical resection completeness on survival in advanced esophageal squamous cell carcinoma.
  • To assess the role of lymph node status and metastasis in determining prognosis.
  • To analyze the effectiveness of three-field lymphadenectomy in staging and treatment.

Main Methods:

  • Retrospective analysis of 212 patients with ESCC treated surgically between 1976 and 1990.

Related Experiment Videos

  • Classification of advanced carcinoma based on lymph node involvement and metastasis.
  • Comparison of survival rates between complete (R0) and incomplete (R1-R2) resections.
  • Evaluation of outcomes following the introduction of three-field lymphadenectomy in 1991.

    • Main Results:

    • Actuarial 5-year survival was 51.2% for lymph node-negative vs. 12.4% for lymph node-positive patients.
    • Complete resection (R0) for stage III/IV carcinoma yielded 20% 5-year survival, versus 0% for incomplete resection (R1-R2).
    • Excluding solid organ metastasis, median survival improved from 8.5 to 20 months with R0 vs. R1-R2 resection.
    • Three-field lymphadenectomy identified positive cervical lymph nodes in 24.3% of patients, reclassifying 16% to M+Ly status.

    Conclusions:

    • Complete surgical resection is paramount for improving survival and locoregional control in advanced ESCC.
    • Lymph node status and the absence of distant metastasis are critical prognostic factors.
    • Three-field lymphadenectomy enhances staging accuracy for advanced esophageal carcinomas.
    • Surgery remains a cornerstone in managing advanced esophageal cancer, contingent upon achieving complete resection.