Sygdomsfri langtidsoverlevelse efter makroradikal operation for cancer oesophagi/cardiae
Sammanfattning
Introduction: We present the long-term survival after curative resection for cancer at the gastro-oesophageal junction. Material and methods: From 1992 through 2003, 147 patients with cancer at the gastro-oesophageal junction underwent curative resection. Preoperative evaluation included a computed tomography (CT) scan of the thorax and abdomen, gastroscopy, endoscopic ultrasonography and ultrasonography of the neck. Results: Explorative laparotomy was performed in 466 patients, and 147 underwent curative resection, while 319 had advanced disease. No patients received adjuvant chemo-radiotherapy. Adenocarcinoma was found in 93% of the patients and squamous cell carcinoma in 7%. Cardia resection was performed in 78%, while 22% underwent gastrectomy. R0 resection was performed in 95% of the operations. Anastomotic dehiscence was seen in 4%. The perioperative mortality after curative resection was 3% and the 180-day-mortality was 5%. The observed five-year survival rate after curative operation was 29% and the estimated five-year survival was 24%. The five-year survival rates according to tumour stage (T1-4) were 85%, 40%, 23% and 25%, respectively. After stratification according to lymph node metastases (-/+metastases) and age below/above 70 years, five-year survival rates were 41%/ 19% and 32%/17%, respectively. Cox regression analysis showed that no metastases (N0) and age below 70 years were independent predictors of survival. Conclusion: The overall and stage-dependent survival after five years, perioperative mortality and complications are acceptable and comparative to those reported by foreign centres.