Prognostic Factors in Patients with Squamous Cell Cancer of the Esophagus Undergoing Transthoracic En Bloc Resection

  • Jürgen D. Roder
  • Raymonde Busch
  • Hubert J. Stein
  • Ulrich Fink
  • J. Rüdiger Siewert
Conference paper


Identification of tumor characteristics which may limit survival in patients with squamous cell carcinoma of the esophagus is critical for the selection of those patients who may benefit from surgical resection and the choice of the radicality of the procedure. We evaluated the tumor characteristics which independently influenced survival in 204 consecutive patients with squamous cell carcinoma of the esophagus who had undergone en bloc resection and extensive lymphadenectomy. Multivariate analysis in the entire patient population identified the presence of residual tumor after resection, i.e., a R1 or R2 resection, and the presence and more than seven mediastinal lymph node metastases as the only independent factors influencing survival time. In a second multivariate analysis of 75 patients who survived the procedure for at least 30 days, who had a R0 resection, and who did not have preoperative neo-adjuvant therapy, only the pN category and the ratio between positive and removed mediastinal lymph nodes independently influenced survival. These data suggest that only a R0 resection, i.e., complete macroscopic and microscopic tumor removal, can increase survival in patients with squamous cell carcinoma of the esophagus. In patients with a limited number of positive mediastinal lymph nodes, the prognosis may be improved by an extensive lymphadenectomy if the number of removed mediastinal lymph nodes exceeds the number of positive nodes by a factor of at least five.


Squamous Cell Carcinoma Esophageal Cancer Esophageal Carcinoma Mediastinal Lymph Node Bloc Resection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Siewert JR, Roder JD, Fink U (1990) Fortschritte in der chirurgischen Behandlung des Plattenepithelkarzinoms der Speiseröhre. Internist 31: 131–142PubMedGoogle Scholar
  2. 2.
    Müller JM, Erasmi H, Stelzner M, Zieren U, Pichlmaier H (1990) Surgical therapy of oesophageal carcinoma. Br J Surg 77: 845–857PubMedCrossRefGoogle Scholar
  3. 3.
    Hermanek P, Scheibe B, Spiessl L, Wagner G (eds) (1987) TNM-Klassifikation maligner Tumoren (UICC), 4th edn. Springer, Berlin Heidelberg New York, pp 42–44Google Scholar
  4. 4.
    Japanese Committee for Registration of Esophageal Carcinoma Cases. Iizuka K et al. (1989) Parameters linked to 10-year survival in Japan of resected esophageal carcinoma. Chest 96: 1005–1011PubMedCrossRefGoogle Scholar
  5. 5.
    Siewert JR, Hölscher AH, Becker K, Gössner W (1987) Kardiacarcinom: Versuch einer therapeutisch relevanten Klassifikation. Chirurg 58: 25–32PubMedGoogle Scholar
  6. 6.
    Siewert JR, Hölscher AH, Roder JD, Bartels H (1988) En bloc Resektion der Speiseröhre beim Oesophaguscarcinom. Langenbecks Arch Chir 373: 367–376PubMedCrossRefGoogle Scholar
  7. 7.
    Japanese Research Society for Gastric Cancer. (1981) Jpn J Surg 11: 127CrossRefGoogle Scholar
  8. 8.
    Akiyama H (1980) Surgery for carcinoma of the esophagus. Curr Probl Surg XVII (2), 55–120Google Scholar
  9. 9.
    Gehan EA (1965) A generalized Wilcoxon test for comparing arbitrarily single-censored samples. Biometrika 52: 203–224PubMedGoogle Scholar
  10. 10.
    Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481CrossRefGoogle Scholar
  11. 11.
    Cox DR (1972) Regression models and life-tables (with discussion). J R Statist Soc B 34: 187–220Google Scholar
  12. 12.
    Sugimachi K, Shinji O, Hiroyuki M, Massaki M, Hideo M, Hiroyuki K (1989) Clinicopathologic study of early stage esophageal carcinoma. Br J Surg 76: 759–763PubMedCrossRefGoogle Scholar
  13. 13.
    Bardini R, Castoro C, Sorrentino P, Borelli P, Ruffatto A, Ruol A, Tremolada C, ü Peracchia A (1989) Prognostic factors for squamous cell carcinoma of the thoracic esophagus after curative resection. Proceedings 4th World Congress of the International Society for Diseases of the Esophagus, Chicago, 1989, p 47Google Scholar
  14. 14.
    Lund O, Kimose HH, Aagaard MT, Hasenkam JM, Erlandsen M (1990) Risk stratification and long-term results after surgical treatment of carcinomas of the thoracic esophagus and cardia. J Thorac Cardiovasc Surg 99: 200–209PubMedGoogle Scholar
  15. 15.
    Sugimachi K, Matsuura H, Kai H, Kanmatsu T, Inokuchi K, Jingu K (1986) Prognostic factors of esophageal carcinoma: Univariate and multivariate analyses. J Surg Oncol 31: 108–112PubMedCrossRefGoogle Scholar
  16. 16.
    Sugimachi K, Matsuoka H, Ohno S, Mori M, Kuwano H (1988) Multivariate approach for assessing the prognosis of clinical oesophageal carcinoma. Br J Surg 75: 1115–1118PubMedCrossRefGoogle Scholar
  17. 17.
    Theunissen PHMH, Borchard F, Poortvliet DCJ (1991) Histopathological evaluation of oesophageal carcinoma: The significance of venous invasion. Br J Surg 78: 930–932PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1993

Authors and Affiliations

  • Jürgen D. Roder
    • 1
  • Raymonde Busch
    • 2
  • Hubert J. Stein
    • 1
  • Ulrich Fink
    • 1
  • J. Rüdiger Siewert
    • 1
  1. 1.Department of SurgeryTechnische Universität MünchenMünchen 80Germany
  2. 2.Section of Statistics and EpidemiologyTechnische Universität MünchenMünchen 80Germany

Personalised recommendations