A comparison of outcome after resection for squamous cell carcinomas and adenocarcinomas of the esophagus and cardia

Abstract

Among 625 patients with squamous cell carcinoma and 134 patients with adenocarcinoma of the esophagus and cardia, a one stage resection was performed upon 375 patients of the squamous carcinoma group (excluding pharyngolaryngoesophagectomy) and 92 patients in the adenocarcinoma group. The patients formed the basis of the current analysis. Male to female ratio was 7:1 for those with squamous carcinoma compared with 3.6:1.0 for those with adenocarcinoma (p = 0.037). Most squamous carcinomas were located in the middle one-third (56.3 percent) and lower one-third (33.0 percent) of the esophagus. Adenocarcinomas were predominantly found at the cardia (91.3 percent) and lower one-third (6.5 percent). Postoperatively, respiratory complications occurred in 34.4 percent of patients in the group with squamous carcinoma and in 19.6 percent of patients in the group with adenocarcinoma (p = 0.01). Cardiac complications occurred in 28.3 percent of patients in the group with squamous carcinoma and in 16.3 percent of patients in the group with adenocarcinoma (p = 0.03). Anastomotic leaks were uncommon for both groups (4.3 and 5.4 percent, respectively). Anastomotic recurrence occurred in 6.1 and 7.6 percent of patients, respectively. Respiratory complications, malignant cachexia and sepsis accounted for most of the deaths in the hospital. The 30 day mortality rates for patients with squamous carcinoma and adenocarcinoma were comparable (4.8 and 6.5 percent, respectively) (p = 0.33). After 30 days, mortality rates differed significantly (11.7 and 3.3 percent, respectively) (p = 0.026). The overall hospital mortality rates, however, were comparable (16.5 and 9.8 percent, respectively) (p = 0.14). The overall five year survival rate for both groups was 15 percent. For patients with squamous carcinomas, the five year survival rate after curative resection was 31 percent compared with 5 percent for palliative resection. For patients with adenocarcinomas, the respective five year survival rates were 35 and zero percent. It was concluded that the two types of tumor differ significantly in the incidence of postoperative morbidity, but mortality and the long term survival rates were similar.