Changing patterns and surgical results in adenocarcinoma of the oesophagus

Prognosis of oesophageal adenocarcinoma is notoriously dismal. To examine the changing patterns of and treatment strategies for this disease, the longitudinal experience of a single institution over 16 years is reported.

The study comprised a retrospective review of 551 consecutive patients operated on for oesophageal cancer between 1979 and 1995, of whom 164 had adenocarcinoma. There were 13 women and 151 men whose mean age was 61 (range 17-82) years.

The prevalence of adenocarcinoma (P = 0.002), that of early tumours (P < or = 0.10), and the resectability rate (P < or = 0.05) increased throughout the period whereas operative mortality rate decreased (P < or = 0.10). Surgical approach changed without influence on long-term survival. Patients referred from endoscopic surveillance programmes for Barrett's oesophagus (n = 16) had an improved survival rate compared with that of non-surveyed patients (P < or = 0.01). Overall 5-year survival after oesophagectomy (17 per cent) improved for the period 1991-1995 when compared with 1979-1982 (P < or = 0.02). Univariate analysis identified tumour node metastasis (TNM) stage, number of diseased lymph nodes, invasion of the oesophageal stump and occurrence of a postoperative complication as significant prognostic variables (P < or = 0.05). Multivariate analysis demonstrated that T stage (P = 0.0002) was the main independent predictor.

Recent improvement of results reflects patient selection, increased prevalence of early tumours, and dramatic reduction of the risks from oesophagectomy. New therapeutic directions should be investigated for locally advanced tumours.