Esophageal cancer: results of an American College of... : Journal of the American College of Surgeons (original) (raw)

Original Scientific Articles

Esophageal cancer: results of an American College of Surgeons patient care evaluation study1

Daly, John M MD, FACSa; Fry, Willard A MD, FACSb; Little, Alex G MD, FACSc; Winchester, David P MD, FACSb; McKee, Rosemary F CTRd; Stewart, Andrew K MAe,*; Fremgen, Amy M PhDe

aDepartment of Surgery, New York Presbyterian Hospital—Weill Medical College of Cornell University, New York, NY, USA (Daly)

bDepartment of Surgery, Evanston Northwestern Healthcare, Evanston, IL, USA (Fry, Winchester)

cDepartment of Surgery, University of Nevada School of Medicine, Las Vegas, NV, USA (Little)

dMethodist Hospitals Health System, Cancer Registry, San Antonio, TX, USA (McKee)

eThe American College of Surgeons, Commission on Cancer, Chicago, IL, USA (Stewart, Fremgen)

Correspondence address: Andrew K Stewart, MA, The American College of Surgeons, Commission on Cancer, 633 N Saint Clair St, Chicago, IL 60611

Submitted October 22, 1999; accepted December 8, 1999.

Presented at the American College of Surgeons 85th Annual Clinical Congress, San Francisco, CA, October 1999.

1No competing interests declared.

Abstract

Background: The last two decades have seen changes in the prevalence, histologic type, and management algorithms for patients with esophageal cancer. The purpose of this study was to evaluate the presentation, stage distribution, and treatment of patients with esophageal cancer using the National Cancer Database of the American College of Surgeons.

Study Design: Consecutively accessed patients (n = 5,044) with esophageal cancer from 828 hospitals during 1994 were evaluated in 1997 for case mix, diagnostic tests, and treatment modalities.

Results: The mean age of patients was 67.3 years with a male to female ratio of 3:1; non-Hispanic Caucasians made up most patients. Only 16.6% reported no tobacco use. Dysphagia (74%), weight loss (57.3%), gastrointestinal reflux (20.5%), odynophagia (16.6%), and dyspnea (12.1%) were the most common symptoms. Approximately 50% of patients had the tumor in the lower third of the esophagus. Of all patients, 51.6% had squamous cell histology and 41.9% had adenocarcinoma. Barrett’s esophagus occurred in 777 patients, or 39% of those with adenocarcinoma. Of those patients that underwent surgery initially, pathology revealed stage I (13.3%), II (34.7%), III (35.7%), and IV (12.3%) disease. For patients with various stages of squamous cell cancer, radiation therapy plus chemotherapy were the most common treatment modalities (39.5%) compared with surgery plus adjuvant therapy (13.2%). For patients with adenocarcinoma, surgery plus adjuvant therapy were the most common treatment methods. Disease-specific overall survival at 1 year was 43%, ranging from 70% to 18% from stages I to IV.

Conclusions: Cancer of the esophagus shows an increasing occurrence of adenocarcinoma in the lower third of the esophagus and is frequently associated with Barrett’s esophagus. Choice of treatment was influenced by tumor histology and tumor site. Multimodality (neoadjuvant) therapy was the most common treatment method for patients with esophageal adenocarcinoma. The use of multimodality treatment did not appear to increase postoperative morbidity.