Preoperative Radiation Therapy is an Independent and Strong Risk Factor for Late Non-cancer Death after Esophagectomy

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Objective: The aim of this study was to reveal the factors that influence the prognosis of esophageal cancer patients, especially from the other causes than esophageal cancer in the follow-up period after esophagectomy.Method: All of 523 patients with esophageal carcinoma who underwent esophagectomy in a single institute between 1986 and 1999 were followed-up until the end of October 2003. Their prognoses were reviewed and compared by the presence of pre/post-operative radiation, pre/post-operative chemotherapy, surgical procedure, and pathological stages of tumors as well as preoperative general conditions by uni- and multivariate analyses. Results: Univariate analysis revealed that sex (male against female) (p=0.005), abnormality on ECG (p=0.012), and the presence of preoperative radiation (p=0.016) significantly increased the incidence of non-esophageal cancer death; on the other hand, thoracoscopic approach decreased the incidence of non-esophageal cancer death. Multivariate analyses revealed that the presence of preoperative radiation significantly increased mortality due to non-esophageal cancer causes to a 3.70 hazard ratio (95% CI [95% Confidence Interval]; 1.33–10.61).Conclusions: This study clearly showed the late effect of preoperative radiation for carcinoma of the esophagus on the postoperative prognosis, especially in terms of later mortality from causes other than esophageal carcinoma.