Trends in management and prognosis for esophageal cancer surgery: twenty-five years of experience at a single institution.

Objective To investigate trends in results of esophagectomies to treat esophageal cancer at a single high-volume institution during the past 25 years. Design and Setting Retrospective cohort study in a university tertiary referral center. Patients and Methods Patients with cancer of the thoracic esophagus or esophagogastric junction seen from 1980 through 2004 were included (N = 3493). Three time periods were defined: 1980-1987, 1988-1995, and 1996-2004. Main Outcome Measures Clinical presentation, tumor characteristics, and morbidity, mortality, and survival rates among patients with esophageal cancer undergoing esophagectomy. Results The ratio of squamous cell carcinoma to adenocarcinoma decreased from 3.3 to 1.7 ( P P P P Conclusions A change in location and histological type of esophageal cancer has occurred during the past 25 years. Earlier diagnosis, a multidisciplinary approach, and refinements in surgical technique and perioperative care have led to a significant reduction in postoperative mortality rate and improved long-term survival among patients with cancer of the thoracic esophagus or esophagogastric junction.