In the Journals

Esophageal cancer surgery earlier in the week results in better prognosis

A recent study demonstrated that esophagectomy for esophageal cancer performed later in the week was associated with increased 5-year mortality.

“The mechanism behind our results is still unknown,” Jesper Lagergren, MD, PhD, consultant and professor of surgery at Karolinska Institutet and King's College London, said in a press release. “But it’s possible that surgical precision to some extent declines towards the end of the week, due perhaps to the accumulated burden on the surgeon and his or her team.”

Lagergren and colleagues used national registry data to evaluate associations between weekday of surgery and 5-year all-cause and disease-specific mortality in a nationwide population-based cohort representing 98% of all esophageal cancer patients who underwent elective surgery in Sweden from January 1987 through December 2010, and were followed up until November 13, 2014. A total of 1,748 patients were included in the final analysis, and grouped based on having undergone surgery Monday or Tuesday (n = 1,083; mean age, 65 years; 76% men) or from Wednesday to Friday (n = 665; mean age, 66 years; 73% men).

Surgeries performed from Wednesday to Friday were associated with increased all-cause 5-year mortality (adjusted HR = 1.13; 95% CI, 1.01-1.26) and increased disease-specific 5-year mortality (HR = 1.15; 95% CI, 1.02-1.29) compared with surgeries performed Monday or Tuesday. When each weekday was analyzed as a discrete variable, there was an average 7% increase in 5-year all cause and disease-specific mortality for each weekday (both, HR = 1.07; 95% CI, 1.02-1.12), and there was a 46% and 44% increase in both respective outcomes when comparing Monday vs. Friday surgeries (HR = 1.46; 95% CI, 1.15-1.85; HR = 1.44; 95% CI, 1.13-1.84).

These associations for all-cause mortality were especially strong for early tumor stages 0-I (HR = 1.59; 95% CI, 1.17-2.16) and moderate for stage II tumors (HR = 1.28; 95% CI, 1.07-1.53), but there was no association found for advanced tumor stages III-IV. When each weekday was analyzed as a discrete variable, there was an average 24% increase in all-cause mortality for each weekday for early tumor stages (HR = 1.24; 95% CI, 1.09-1.41) and 13% for stage II (HR = 1.13; 95% CI, 1.05-1.22), but no increase was associated with advanced stages. Comparable associations were observed for disease-specific 5-year mortality.

“More studies are needed to confirm these results, before anyone goes and issues clinical recommendations,” Lagergren said in the press release. “But if these results end up being corroborated by future research, esophageal cancer surgery should be planned to take place primarily at the beginning of the week.” – by Adam Leitenberger

Disclosures: The researchers reports no relevant financial disclosures. 

A recent study demonstrated that esophagectomy for esophageal cancer performed later in the week was associated with increased 5-year mortality.

“The mechanism behind our results is still unknown,” Jesper Lagergren, MD, PhD, consultant and professor of surgery at Karolinska Institutet and King's College London, said in a press release. “But it’s possible that surgical precision to some extent declines towards the end of the week, due perhaps to the accumulated burden on the surgeon and his or her team.”

Lagergren and colleagues used national registry data to evaluate associations between weekday of surgery and 5-year all-cause and disease-specific mortality in a nationwide population-based cohort representing 98% of all esophageal cancer patients who underwent elective surgery in Sweden from January 1987 through December 2010, and were followed up until November 13, 2014. A total of 1,748 patients were included in the final analysis, and grouped based on having undergone surgery Monday or Tuesday (n = 1,083; mean age, 65 years; 76% men) or from Wednesday to Friday (n = 665; mean age, 66 years; 73% men).

Surgeries performed from Wednesday to Friday were associated with increased all-cause 5-year mortality (adjusted HR = 1.13; 95% CI, 1.01-1.26) and increased disease-specific 5-year mortality (HR = 1.15; 95% CI, 1.02-1.29) compared with surgeries performed Monday or Tuesday. When each weekday was analyzed as a discrete variable, there was an average 7% increase in 5-year all cause and disease-specific mortality for each weekday (both, HR = 1.07; 95% CI, 1.02-1.12), and there was a 46% and 44% increase in both respective outcomes when comparing Monday vs. Friday surgeries (HR = 1.46; 95% CI, 1.15-1.85; HR = 1.44; 95% CI, 1.13-1.84).

These associations for all-cause mortality were especially strong for early tumor stages 0-I (HR = 1.59; 95% CI, 1.17-2.16) and moderate for stage II tumors (HR = 1.28; 95% CI, 1.07-1.53), but there was no association found for advanced tumor stages III-IV. When each weekday was analyzed as a discrete variable, there was an average 24% increase in all-cause mortality for each weekday for early tumor stages (HR = 1.24; 95% CI, 1.09-1.41) and 13% for stage II (HR = 1.13; 95% CI, 1.05-1.22), but no increase was associated with advanced stages. Comparable associations were observed for disease-specific 5-year mortality.

“More studies are needed to confirm these results, before anyone goes and issues clinical recommendations,” Lagergren said in the press release. “But if these results end up being corroborated by future research, esophageal cancer surgery should be planned to take place primarily at the beginning of the week.” – by Adam Leitenberger

Disclosures: The researchers reports no relevant financial disclosures.