Weekday of Esophageal Cancer Surgery and Its Relation to Prognosis.

Abstract

To assess whether weekday of surgery influences long-term survival in esophageal cancer. Increased 30-day mortality rates have been reported in patients undergoing elective surgery later compared with earlier in the week. This population-based cohort study included 98% of all esophageal cancer patients who underwent elective surgery in Sweden in 1987 to 2010, with follow-up until 2014. The association between weekday of surgery and 5-year all-cause and disease-specific mortality was analyzed using a multivariable Cox proportional hazards model, providing hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, comorbidity, tumor stage, histology, neoadjuvant therapy, and surgeon volume. Among 1748 included patients, surgery conducted from Wednesday to Friday entailed 13% increased all-cause 5-year mortality compared with surgery conducted from Monday to Tuesday (HR = 1.13, 95% CI, 1.01-1.26). The corresponding association was strong for early tumor stages (0-I) (HR = 1.59, 95% CI, 1.17-2.16), moderate for intermediate tumor stage (II) (HR = 1.28, 95% CI, 1.07-1.53), and absent in advanced tumor stages (III-IV) (HR = 0.93, 95% CI, 0.79-1.09). The increase in 5-year mortality for each later weekday (discrete variable) was 7% for all tumor stages (HR = 1.07, 95% CI, 1.02-1.12), 24% for early tumor stages (HR = 1.24, 95% CI, 1.09-1.41), 13% for intermediate stage (HR = 1.13, 95% CI, 1.05-1.22), whereas no increase was found for advanced stages (HR = 0.98, 95% CI, 0.92-1.05). The disease-specific 5-year mortality was similar to the all-cause mortality. The increased 5-year mortality of potentially curable esophageal cancer after surgery later in the week suggests that this surgery is better carried out earlier in the week.