441. ESOPHAGEAL CANCER MANAGEMENT IN A SWISS REFERRAL CENTER; A 20-YEAR EXPERIENCE

Abstract

Abstract In the past decades, management of esophageal cancer (EC) has significantly changed with the widespread use of oncological treatments, as well as minimally invasive surgery and enhanced recovery protocols. Concurrently, the histological type, comorbidity status and life expectency of the ‘typical’ EC patient have also evolved. The aim of this study was to assess the evolution in epidemiology, management and outcomes of EC patients treated in a Swiss tertiary referral center the last 20 years. Baseline demographics, clinico-pathological data, treatment details and postoperative outcomes were retrieved from our institutional prospective database for all consecutive patients operated for esophageal cancer with curative intent. Emergency surgery and endoscopic treatment of early EC were excluded, hence 332 patients (265 male, 67 female) were included in the final analysis. Patients were divided in 3 groups: ‘historical group’: 2000–2007, n = 73; ‘transition group’: 2008–2014, n = 108; ‘modern group’: 2015–2020, n = 151. Comparison was performed with the x2 test for discrete and the ANOVA tests for continuous variables, with the Bonferroni method to determine significance in pairwise comparisons (p < 0.05). The annual caseload doubled (10 to 25 cases/y). Alcohol consumption (57.5% to 28.5%, p < 0.001), active smoking (64.4% to 38.4%, p = 0.001) and COPD (41.1% to 35.1%, p = 0.05) decreased. Squamous cell carcinoma (58.9% historic, 34.4% modern group) was replaced by adenocarcinoma as the most prevalent type (35.6% vs 64.2%, p = 0.001). Detection of locally advanced disease increased from 58.8% to 75.8% (p = 0.022), along with the use of neoadjuvant treatment (34.2% historic, 83.4% modern group, p < 0.001). Major postoperative morbidity was documented in 34.2% of patients (historic group) versus 58.3% (modern group, p = 0.002), but mortality remained stable. No differences were observed in long-term survival. Centralization significantly increased the annual caseload. Improved preoperative workup enabled more accurate detection of locally advanced disease and subsequently appropriate multimodal treatment that is currently used in most patients. The ‘typical’ EC patient has shifted from the squamous cell to the adenocarcinoma type, but males are still more concerned. Postoperative complications are nowadays more rigorously detected and managed, keeping mortality rates low. Long-term survival remained unchanged over time.