University of Oulu

Saviaro H, Rintala J, Kauppila JH, Yannopoulos F, Meriläinen S, Koivukangas V, Huhta H, Helminen O, Saarnio J. Thirty years of esophageal cancer surgery in Oulu University Hospital. J Thorac Dis 2021;13(8):4638-4649. doi: 10.21037/jtd-21-520

Thirty years of esophageal cancer surgery in Oulu University Hospital

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Author: Saviaro, Henna1; Rintala, Jukka1; Kauppila, Joonas H.1,2;
Organizations: 1Surgery Research Unit, Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
2Upper Gastrointestinal Surgery, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.3 MB)
Persistent link:
Language: English
Published: AME Publishing Company, 2021
Publish Date: 2021-10-27


Background: Esophagectomy is the mainstay of surgical treatment of esophageal cancer, but involves high operative risk. The aim of this study was to review the evolution surgical treatment of esophageal cancer in Northern Finland, with introduction of minimally invasive techniques.

Methods: All elective esophagectomies performed in Oulu University Hospital between years 1987 and 2020 were included. Treatment strategies were compared to current guidelines including staging and use of neoadjuvant therapy, and benchmark values including postoperative morbidity, hospital stay, readmissions and 90-day mortality. Long-term survival was compared to previous national studies.

Results: Between years 1987 and 2020 a total of 341 underwent an esophagectomy. Transhiatal resection was performed to 167 (49.3%), Ivor Lewis to 129 (38.1%) and McKeown to 42 (12.4%) patients. MIE was performed to 49 (14.5%) patients. During the past four years 83.7% of locally advanced diseases received neoadjuvant treatment. Since 1987, gradual improvements have occurred especially in incidence of pleural effusion requiring additional drainage procedure (highest in 2011–2013 and in last four years 14.0%), recurrent nerve injuries (highest in 2008–2010 29.4% and lowest in 2017–2020 1.8%) and in 1-year survival rate (1987–1998 68.4% vs. 2017–2020 82.1%). No major changes in comorbidity, complication rate, anastomosis leaks, hospital stay or postoperative mortality were seen.

Conclusions: Esophageal cancer surgery has gone through major changes over three decades. Current guideline-based treatment has resulted with progressive improvement in mid- and long-term survival. However, despite modern protocol, no major improvement has occurred for example in major complications, anastomosis leak rates or hospital stay.

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Series: Journal of thoracic disease
ISSN: 2072-1439
ISSN-E: 2077-6624
ISSN-L: 2072-1439
Volume: 13
Issue: 8
Pages: 4638 - 4649
DOI: 10.21037/jtd-21-520
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
3122 Cancers
Funding: This work was supported by grants from Instrumentarium Science Foundation (OH), Finnish State Research Funding (OH), Georg C. and Mary Ehrnrooth Foundation (OH) and the Finnish Medical Foundation. Orion Research Foundation (JHK), Thelma Mäkikyrö Foundation (JHK, HH) and Mary and Georg C. Ehrnroot Foundation (JHK, HH), The Finnish cultural Foundation (HH), Vieno and Alli Suorsa’s health care foundation (HH), Päivikki and Sakari Sohlberg Foundation (JHK), The Finnish Cancer Foundation (JHK), and Sigrid Juselius Foundation (JHK).
Copyright information: © Journal of Thoracic Disease. All rights reserved. This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: