Prognosis

Esophageal cancer remains one of the most lethal of all malignancies. Without aggressive treatment, the cancer tends to obstruct the esophagus and cause severe dysphagia. In addition to local progression causing pain, the disease tends to metastasize widely to the lungs, liver, and bone.

Survival depends on stage of disease and treatment; lymph node involvement is an important determinant of survival.[245] Favorable prognostic factors include early-stage disease and complete resection.

Based upon US data from 2011 to 2017, 5-year relative survival rates for people diagnosed with localized, regional, and distant esophageal cancer are 46.4%, 25.6%, and 5.2%, respectively.[246] Overall 5-year survival rate (all stages of disease) is 22%.[8]​ Five-year survival rates for esophageal adenocarcinoma may be slightly better than those for squamous cell carcinoma (localized stage at diagnosis 51.1% vs. 32.0%; regional 26.5% vs. 24.0%; distant 5.0% vs. 6.1%, respectively). A large pooled analysis found that women treated for esophageal cancer had significantly improved survival versus men.[247] Chemotherapy-induced gastrointestinal toxicities were also more prevalent in women.[247]

Randomized studies demonstrate that, compared with standard transthoracic esophagectomy, both minimally invasive transthoracic esophagectomy and hybrid minimally invasive esophagectomy (an Ivor Lewis procedure with laparoscopic gastric mobilization and limited open right thoracotomy) lead to significantly lower rates of postoperative complications and accelerated recovery, without compromising survival benefit.[152][153] One systematic review and meta-analysis reported that long-term survival following minimally invasive esophagectomy compares favorably with, and may even be better than, open esophagectomy in patients with esophageal cancer.[248]

Esophagectomy is a high-risk procedure with an incidence rate of major complications around 25% to 40%.[249][250] One systematic review found that male sex and diabetes were prognostic factors for anastomotic leakage and major complications.[250]

Data suggest that esophagectomy is most safely performed in high-volume units. The mortality of this procedure in such centers ranges from 2% to 6%. However, serious complications are frequent, and may occur in 20% to 40% of cases.[249] The most common complications are pulmonary disorders (10% to 50%), cardiac dysrhythmias (10%), and anastomotic leak (5% to 10%). When the anastomosis is made in the neck, a leak is rarely the cause of serious morbidity. However, dissection in the neck does carry the potential risk of temporary or even permanent recurrent laryngeal nerve injury. Average hospital stay following esophagectomy is 10-14 days.[251][252]

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