Resectional surgery in carcinoma of the oesophagus and cardia: what influences long-term survival?

OBJECTIVE Our objectives were to determine factors which influence survival after resectional surgery in patients with cancer of the oesophagus and cardia. PATIENTS AND METHOD 562 consecutive patients with primary cancer of the oesophagus or gastric cardia (oesophago-gastric junction) undergoing resectional surgery and reconstruction of the oesophagus were studied. Operative approach depended on tumour location, the aim being complete resection of the tumour and associated lymph nodes. Postoperative staging was based on tumour, nodes and metastasis (TNM) classification. RESULTS There were 342 males and 220 females, aged 61.8 +/- 12.8 years. Histology of the tumours was: squamous cell carcinoma 49%, adenocarcinoma 47.5% and other tumours 3.5%. The location of tumours within the oesophagus was: cervical (n = 32), upper thoracic (n = 18), middle thoracic (n = 241) and lower thoracic and gastric cardia (n = 271). Of the tumours 16% were stage I, 10% stage II and 74% stage III. Hospital mortality rate was 9% overall, significantly higher in cervical tumours (cervical tumours versus lower and or middle oesophageal tumours: P < 0.05), the elderly (age > 75 years versus age < 75 years: P < 0.05) and stage III disease (stage III versus stage I: P < 0.001). The overall 5-year survival rate was 18%. There was no correlation between tumour histology, location or type of operation and long-term survival. Survival disease-free for 5 years or more was 73% for stage I, 15.8% for stage II and 6% for stage III. The only significant correlation was between the stage of disease and long-term survival (stage I versus stage III P < 0.001, stage I versus stage II P < 0.05). CONCLUSIONS Immediate results are affected by a number of factors but long-term survival is related entirely to the stage of the tumour.