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Increased Platelet Counts after Transthoracic En Bloc Resection for Esophageal Cancer is Associated with Significantly Improved Survival

Ling, Frederike ; Vallböhmer, Daniel ; Hoelscher, Arnulf ; Schmidt, Daniel ; Bollschweiler, Elfriede ; Schneider, Paul

In: World Journal of Surgery, 2010, vol. 34, no. 11, p. 2628-2634

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    Titre
    • Increased Platelet Counts after Transthoracic En Bloc Resection for Esophageal Cancer is Associated with Significantly Improved Survival
    Auteur
    • Ling, Frederike. Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
    • Vallböhmer, Daniel. Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
    • Hoelscher, Arnulf. Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
    • Schmidt, Daniel. Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
    • Bollschweiler, Elfriede. Department of General, Visceral and Cancer Surgery, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
    • Schneider, Paul. Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • World Journal of Surgery, 2010, vol. 34, no. 11, p. 2628-2634. Springer-Verlag
    Autre version électronique
    Classification
    • Santé
    Identifiant OAI-PMH
    • oai:doc.rero.ch:312351
    Summary
    Background: We analyzed perioperative platelet counts as a potential clinical marker for survival after transthoracic en bloc resection for esophageal cancer. Recent data described preoperative thrombocytosis in malignancies to be associated with poor prognosis. Methods: A retrospective analysis from a prospective database (1997-2006) was performed for 291 consecutive patients with esophageal cancer who underwent transthoracic en bloc esophagectomy and extended lymphadenectomy. Squamous cell cancer was found in 47.0% and adenocarcinoma in 50.9% (2.1% had rare histologies). Neoadjuvant chemoradiation was performed in 152 (52%) patients. Platelet counts before surgery and on postoperative days (PODs) 1, 10, and 30 were evaluated. We used the published cutoff value of 293×109/l (mean of 80 healthy controls±standard deviation) for platelet counts. Results: High platelet counts before surgery missed significance for poorer survival (p=0.054). Following a perioperative fall in thrombocytes, a significant rise at POD 10 after surgery was evident. Platelet counts of more than 293×109/l at this time correlated with a significantly improved survival rate (p=0.027). Patients with no increase in thrombocytes until POD 10 had significantly poorer survival (p=0.012). Multivariate analysis confirmed that a thrombocyte increase between the preoperative count and that on POD 10 is an independent prognostic indicator (p=0.035) for patients with completely (R0) resected tumors. Conclusions: An increase in platelet counts measured on POD 10 following transthoracic en bloc esophagectomy and extended lymphadenectomy is an independent prognostic indicator for improved survival in patients with esophageal cancer