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Invited Critique
March 16, 2009

Trends in Management and Prognosis for Esophageal Cancer—Invited Critique

Arch Surg. 2009;144(3):254. doi:10.1001/archsurg.2008.560

The review by Ruol et al of data from nearly 3500 patients with esophageal cancer treated at the University of Padova during a 25-year period confirms much of our current understanding of esophageal cancer. There have been changes in tumor location (proximal to distal) and histological type (squamous cell carcinoma to adenocarcinoma), enhanced multidisciplinary treatment algorithms, and improved surgical mortality and overall survival rates. According to Ruol et al, most of their patients, even in the most recent time period from 1996-2004, had squamous cell carcinoma. In addition, most patients were treated with thoracotomy-based resections, and, enviably, more than 70% of patients had 15 or more lymph nodes resected. Increasing use of preoperative chemoradiotherapy was temporally associated with increased R0 resection and long-term survival rates. The authors comment that a history of Barrett esophagus was disclosed in less than 30% of patients with adenocarcinoma, data that may lead to improved use of screening endoscopy in their population. They do not comment on the presence of Barrett epithelium in the resected specimens.

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