Abstract 2662: Racial disparities in the surgical outcomes after esophagectomy for esophageal cancer

Abstract

Abstract Introduction: Despite advances in the management of esophageal cancer, African American patients continue to have poorer outcomes following esophagectomy for esophageal cancer. The reasons for this are multifactorial, including access to care and cultural perceptions of treatments. For those patients who underwent esophagectomy, we sought to evaluate if there were disparities in outcomes for African American patients. Method: We identified African American and Caucasian patients who underwent esophagectomy for esophageal cancer at a single, high volume institution. from 1974 to 2011. Using Chi-square and Fisher's exact test, we evaluated for differences in perioperative risk factors, postoperative complications and long term survival. Results: 2090 (2.7% African Americans, 97.3% Caucasians) patients were included in the study. No significant difference was seen in anastomotic leaks, chylothoraces, hoarseness, or other postop complications. However, more African Americans were sent to the intensive care unit during their postop hospitalization (62% versus 46%, p= 0.02). In addition, African Americans had a significantly longer hospitalization compared to their Caucasian counterparts (19 versus 12 days, p<0.0001). This difference persisted even after adjusting for histology, preoperative staging, age, gender, alcohol and tobacco use. Squamous cell cancer was more likely to be seen in African Americans than in Caucasians (79% versus 20% respectively, p<0.0001). Adenocarcinoma was more often seen in Caucasians than African Americans (78% vs 21%, p<0.0001) as were Barrett's changes (33% versus 10%, p=0.003). Despite the longer hospitalizations, there was no significant difference in the long term survival (weeks) between African Americans and Caucasians. Conclusion: African Americans have equal survival to Caucasians after esophagectomy for esophageal cancer at single, high volume institution. Despite having longer hospitalizations with more ICU admissions after surgery, there were no significant differences in postoperative complications or long term survival based on race. Differences in outcomes in patients with esophageal cancer may be related to initial access to care, but there doesn't appear to be a difference in outcomes once patients proceed to surgery at an experienced center. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 2662. doi:1538-7445.AM2012-2662