Superficial adenocarcinoma of the esophagus

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Presentation transcript:

Superficial adenocarcinoma of the esophagus Thomas W. Rice, MDa, Eugene H. Blackstone, MDa,b, John R. Goldblum, MDc, Malcolm M. DeCamp, MDa, Sudish C. Murthy, MD, PhDa, Gary W. Falk, MDd, Adrian H. Ormsby, MBChBc, Lisa A. Rybicki, MSb, Joel E. Richter, MDd, David J. Adelstein, MDe The Journal of Thoracic and Cardiovascular Surgery Volume 122, Issue 6, Pages 1077-1090 (December 2001) DOI: 10.1067/mtc.2001.113749 Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 1 Superficial adenocarcinoma of the esophagus: depth of tumor invasion. The left-hand portion of the picture is an expanded view of a cross-section of the esophagus (lower right). HGD, High-grade dysplasia, which is intraepithelial carcinoma without invasion of the basement membrane; T1a, T1 intramucosal invasion of the lamina propria or muscularis mucosa, but not beyond; and T1b, T1-submucosal carcinoma with invasion limited to the submucosa. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 1077-1090DOI: (10.1067/mtc.2001.113749) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 2 Accrual of cases by rear of operation. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 1077-1090DOI: (10.1067/mtc.2001.113749) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 3 Survival stratified according to patients not experiencing postoperative respiratory failure (open circles) compared with patients experiencing respiratory failure (open squares). The number of patients at risk at various time points is given along with confidence limits equivalent to 1 standard deviation (see “Patients and Methods”). The Journal of Thoracic and Cardiovascular Surgery 2001 122, 1077-1090DOI: (10.1067/mtc.2001.113749) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 4 Survival after operation. Nonparametric Kaplan-Meier time-related estimates are presented as open circles accompanied by asymmetric confidence limits equivalent to 1 standary error. The smooth soild curve is the completely independent parametric estimate of the distribution on intervals to death. These are accompanied by confidence limits equivalent to 1 standard error. The numbers in parentheses represent the number of patients being follwed up at the point in time. A, Survival. B, Hazard function. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 1077-1090DOI: (10.1067/mtc.2001.113749) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 5 Ten-year survival according to FEV1 in 2 patients. One patient has high-grade dysplasia (HGD) on preoperative biopsy and the other invasive adenocarcinoma (Adeno ). Both patients are in a Barrett surveillance program, and both would have a planned transhiatal esophagectomy. The depiction represents 2 solutions of the decision model (Table 4). Note the evident differences (nonoverlapping lower and upper confidence limits) below FEV1s of approximately 2 L. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 1077-1090DOI: (10.1067/mtc.2001.113749) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 6 Ten-year predicted survival in a low- and high-risk patient. The low-risk patient has an average FEV1 of 3 L, is in a Barrett surveillance program, and has high-grade dysplasia on biopsy; a transhiatal approach is planned. The high-risk patient has an FEV1 of 175 L, is not in a Barrett surveillance program, and has invasive adenocarcinoma on biopsy; a thoracotomy is planned. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 1077-1090DOI: (10.1067/mtc.2001.113749) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 7 Survival stratified according to depth of tumor invasion (T). HGD, High-grade dysplasia. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 1077-1090DOI: (10.1067/mtc.2001.113749) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Fig. 8 Survival stratified according to the presence (N1) or absence (N0) of positive lymph nodes. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 1077-1090DOI: (10.1067/mtc.2001.113749) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Appendix Fig. I. Time trends Appendix Fig. I. Time trends. A, Percent of patients undergoing a transhiatal esophagectomy. B, Percent of patients whose anastomosis was in the neck. C, Percent of patients requiring postoperative reintubation for respiratory failure. D, Percent of patients experiencing an important surgical complication other than wound infection. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 1077-1090DOI: (10.1067/mtc.2001.113749) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Appendix Fig. III. Kaplan-Meier estimates of tumor invasion as in Figure 3. The solid curves are predicted from the prognostication model (Table 5). The inference from this depiction is that the model is sufficient for prognostication, even though it does not contain information directly about depth of tumor invasion. Patients with high-grade dysplasia are well represented by the smooth upper curve, as are patients with T1a tumors by the second curve. After about 3 years, patients with T1b tumors fare worse than predicted, but the number of patients at that point is so small that this additional variable did not provide significant information. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 1077-1090DOI: (10.1067/mtc.2001.113749) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions

Appendix Fig. IV. Survival within age groups compared with a matched US population. The dot-dash curve is the matched survival among patients less than 55 years of age. The dash-dot-dot-dash curve is the population life table for patients between the ages of 55 and 75 years. The lowestdash-dot-dot-dash curve is for the matched population more than 75 years of age. The Journal of Thoracic and Cardiovascular Surgery 2001 122, 1077-1090DOI: (10.1067/mtc.2001.113749) Copyright © 2001 American Association for Thoracic Surgery Terms and Conditions