Improved Long-Term Survival After Esophagectomy for Esophageal Cancer: Influence of Epidemiologic Shift and Neoadjuvant Therapy

The study was done to determine long-term outcomes of surgically treated esophageal cancer and to identify trends in epidemiology, oncological therapy, and oncological prognosis over the last two decades. Overall survival in 304 patients undergoing esophagectomy was analyzed. Fifty-three percent had squamous cell carcinoma and 46 % had adenocarcinoma (AC). A total of 161 patients received neoadjuvant chemoradiation, 38 received neoadjuvant chemotherapy, and 105 were treated with surgery alone. Median survival (MS) increased significantly from 18.0 months (1988-1994) to 26.6 months (1995-2001) and to 59.3 months (2002-2011; p < 0.001). The proportion of AC (22 vs 35 vs 65 %; p < 0.001) and the proportion of patients treated with neoadjuvant therapy (neoT; 15.9 vs 85.3 vs 77.8 %; p < 0.001) increased during the treatment period. After neoT, a beneficial outcome with a MS of 45.6 vs. 20.4 months (p = 0.003) was found. Lymph node ratio [LNR; relative risk (RR), 5.4; p < 0.001], response to neoT (RR, 1.6; p < 0.004), and histological subtype (RR, 1.7; p < 0.003) were identified as independent parameters of survival. Since 1988, the outcome of surgically resected esophageal cancer strongly improved. Besides tumorbiological factors like histological type and LNR, the outcome is also affected by the increasing use of neoT towards favorable survival rates.