Impact of surgical care on survival in esophageal cancer.

Abstract

142 Background: Survival after multimodality treatment of localized esophageal cancer depends upon complex interactions between the patient, tumor biology, and treatment factors. The National Cancer Database (NCDB) was used to analyze prognostic factors to identify areas for treament optimization. Methods: 8,072 patients with localized esophageal cancer treated with neoadjuvant therapy undergoing surgical resection between 2004 and 2006 were identified from the NCDB. Covariates were analyzed for association with survival using univariate and multivariate Cox models. Results: A multiviariate Cox proportional hazards model was constructed, with the following significant factors predictive of survival. (See Table.) Survival varied markedly based upon the annual surgical volume of esophageal resection performed at the hospital. For hospitals performing 5 or fewer esophageal resections per year (15% of cases), 5-year survival was 40.0%, compared with 48.6% for hospitals performing 20 or greater (26% of cases). Hospital length of stay after surgery also profoundly affected survival. For patients with a post-operative length of stay of less than 14 days, 5-year survival was 40% and median survival 39.1 months. Median survival was 28 months, 19 months, and 15 months in patients with a hospital length of stay of 14-21 days, 21-28 days, and greater than 28 days, respectively. Conclusions: Data from the NCDB confirms the association between perioperative events and long-term survival after resection for esophageal cancer. Given the wide variance in outcomes based upon perioperative treatment factors, future improvements in outcomes are unlikely to be dramatically influenced by optimization of chemotherapy and radiation therapy. Improvement in outcomes of the treatment of esophageal cancer will likely require understanding how the perioperative period influences long-term survival, which should drive priorities for research and treatment improvement. [Table: see text]