Evolution of Esophagectomy for Cancer Over 30 Years: Changes in Presentation, Management and Outcomes

Background Esophageal cancer has seen a considerable change in management and outcomes over the last 30 years. Historically, the overall prognosis has been regarded as poor; however, the use of multimodal treatment and the integration of enhanced recovery pathways have improved short- and long-term...

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Bibliographic Details
Published in:Annals of surgical oncology 2021-06, Vol.28 (6), p.3011-3022
Main Authors: Griffin, S. Michael, Jones, Rhys, Kamarajah, Sivesh Kathir, Navidi, Maziar, Wahed, Shajahan, Immanuel, Arul, Hayes, Nick, Phillips, Alexander W.
Format: Article
Language:English
Subjects:
Adenocarcinoma
Aged
Carcinoma, Squamous Cell - pathology
Carcinoma, Squamous Cell - surgery
Esophageal cancer
Esophageal Neoplasms - pathology
Esophageal Neoplasms - surgery
Esophagectomy
Esophagus
Female
Gastrointestinal surgery
Humans
Male
Medical prognosis
Medicine
Medicine & Public Health
Morbidity
Mortality
Neoplasm Staging
Oncology
Patients
Retrospective Studies
Sensory integration
Squamous cell carcinoma
Surgery
Surgical Oncology
Thoracic Oncology
Treatment Outcome
Trends
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Summary:Background Esophageal cancer has seen a considerable change in management and outcomes over the last 30 years. Historically, the overall prognosis has been regarded as poor; however, the use of multimodal treatment and the integration of enhanced recovery pathways have improved short- and long-term outcomes. Objective The aim of this study was to evaluate the changing trends in presentation, management, and outcomes for patients undergoing surgical treatment for esophageal cancer over 30 years from a single-center, high-volume unit in the UK. Patients and Methods Data from consecutive patients undergoing esophagectomy for cancer (adenocarcinoma or squamous cell carcinoma) between 1989 and 2018 from a single-center, high-volume unit were reviewed. Presentation method, management strategies, and outcomes were evaluated. Patients were grouped into successive 5-year cohorts for comparison and evaluation of changing trends. Results Between 1989 and 2018, 1486 patients underwent esophagectomy for cancer. Median age was 65 years (interquartile range [IQR] 59–71) and 1105 (75%) patients were male. Adenocarcinoma constituted 1105 (75%) patients, and overall median survival was 29 months (IQR 15–68). Patient presentation changed, with epigastric discomfort now the most common presentation (70%). An improvement in mortality from 5 to 2% ( p  
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-020-09200-3