Changes in the surgical management of esophageal cancer from 1970 to 1993

Purpose To evaluate the changes since 1970 in the management and outcome of esophageal resection for cancer. Methods The records of all 316 patients who underwent esophageal resection for cancer at University of California Los Angeles Medical Center during the years 1970 to 1993 were reviewed. Results When records from 1984 to 1993 were compared to those from 1970 to 1983, significant decreases were seen in operative mortality (10% to 3%, P<0.01), morbidity (72% to 60%, P<0.05), anastomotic leaks (12% to 5%, P<0.03), and reoperations (20% to 8%, P<0.003). Time spent in hospital and in intensive care decreased 40%. These improvements in short-term outcome were most evident in patients with disease in later stages. The 5-year survival rate increased (12% to 21%, P<0.01). A greater percentage of tumors presented in early stages (21% versus 37%). Conclusions Short-term outcome of surgical resection for esophageal carcinoma improved between 1970 and 1993, in part because of changes in perioperative and surgical management. Long-term survival improved, probably due to earlier detection of tumors.