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Minerva Surgery 2021 Apr 14

DOI: 10.23736/S2724-5691.21.08393-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Effects of therapy modifications during the last decade on the outcome of patients undergoing esophagectomy for esophageal cancer

Florian BUßMEYER 1, Felicia KNEIFEL 1, Ann-Kathrin EICHELMANN 1, Daniel PALMES 1, Richard HUMMEL 2, Kirsten LINDNER 2

1 Department of General and Visceral Surgery, Muenster University Hospital, Muenster, Germany; 2 Department of Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany


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BACKGROUND: During the last decade, numerously therapeutic regimes were assessed to improve the outcome of patients with esophageal carcinoma. We analyzed the impact of therapy alterations, including the establishment of a standardized clinical pathway and the introduction of an interdisciplinary tumor conference on the outcome of patients undergoing esophagectomy because of esophageal cancer.
METHODS: Included were 301 patients (204 adenocarcinoma and 97 squamous cell carcinoma) who underwent an esophagectomy between 2006 and 2015. Patients were divided into 3 groups: Interval A (2006-2008), Interval B (2009-2011) and Interval C (2012-2015) and evaluated separately focusing on therapy management and patients' outcome.
RESULTS: Over the time periods, the incidence of tumor entity of adenocarcinoma increased from 61% to 76.2% (p=0.059). Patients with an initial tumor stage uT1 increased significantly from 4% to 15.9% over the intervals (p=0.002), while positive nodal involvement remained comparable (p=0.237). Patients in the later interval suffered from greater physical impairments preoperatively, represented by a significantly increased American Society Anesthesiologists (ASA) score (p=0.023) and a reduced Karnofsky Index (p<0.001). The tumor conference was accompanied by an increasing implementation of neoadjuvant therapy (27.1% versus 42.2%, p=0.097). After establishing the clinical pathway 30-day mortality decreased (p=0.67). Grad III anastomotic leakage decreased significantly from 6.5% to 2% (p=0.01). However, gastrointestinal (p=0.007), pulmonary complications (p<0.001) including pneumonia (p<0.001) increased. Over the past ten years both overall survival and relapse-free survival prolonged (p=0.056 and p=0.063, respectively).
CONCLUSIONS: Patients ‘collective suffering from esophageal cancer has changed over the last decade. Continuous further developments of the therapy regimes are needed to meet the requirements of reducing perioperative mortality and extending survival time.


KEY WORDS: Esophageal carcinoma; Therapy regime; Interdisciplinary tumor conference; Standardized clinical pathway; Survival

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