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Arch Surg. 2004 Jun;139(6):627-31; discussion 631-3.

En bloc vs transhiatal esophagectomy for stage T3 N1 adenocarcinoma of the distal esophagus.

Author information

  • 1Department of Surgery, Lund University Hospital, Lund, Sweden.

Abstract

HYPOTHESIS:

En bloc esophagectomy (EBE) provides improved survival over transhiatal esophagectomy (THE) in patients with similarly sized transmural tumors (T3) and lymph node metastases (N1).

DESIGN:

A retrospective case-control study of 2 methods of esophageal resection for cancer.

SETTING:

University hospital (tertiary referral center for esophageal disease).

PATIENTS:

There were 49 patients (27 who underwent EBE and 22 who underwent THE) with similar T3 N1 disease and the following matched criteria: tumors of similar size and location, more than 20 lymph nodes in the surgical specimen, R0 resection, no previous chemotherapy or radiation therapy, and follow-up until death or for a minimum of 5 years. Main Outcome Measure Survival adjusted for differences in demographic and patient characteristics.

RESULTS:

The number of nodes harvested was greatest after EBE vs THE (median, 52 vs 29 [range, 21-85 vs 20-60]; P<.001). The median number of involved nodes was similar after EBE vs THE (median, 5 vs 7 [range, 1-19 vs 1-16]). The only 2 independent factors that affected survival in a Cox analysis were the number of involved lymph nodes (P =.01) and the type of resection (P =.03). Patients who underwent EBE had a survival benefit over those who underwent THE (P =.01). The survival benefit of EBE was seen only in patients with fewer than 9 involved lymph nodes (P<.001).

CONCLUSION:

En bloc esophagectomy confers a better survival than THE in patients with T3 N1 disease and fewer than 9 lymph node metastases.

PMID:
15197089
[PubMed - indexed for MEDLINE]
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