Delayed vs. early surgery linked to shorter survival in advanced esophageal cancer
Key takeaways:
- Researchers reported a 45% reduction in the relative survival rate for those who experienced delays compared with those who had early surgery.
- Patients with stage II to stage III disease who underwent early surgery had a 5-year survival rate of 41.6% vs. 22.9% for those who had delayed surgery .
- “Timely surgery for patients with stage II to stage III esophageal cancer should be prioritized whenever possible,” researcher says.
Early surgery prolonged survival compared with delayed surgery among patients with stage II to stage III esophageal cancer, according to study results published in Journal of the American College of Surgeons.
Patients with delayed surgery experienced a 45% reduction in relative survival vs. those who underwent early surgery, researchers noted.
Rationale and methods
“Throughout the COVID-19 pandemic, hospitals have been delaying cancer care and elective surgeries because of limited resources, and patients have sometimes independently delayed their own care because of fears of being infected with COVID-19,” Simar S. Bajaj, research fellow at Massachusetts General Hospital and Stanford University School of Medicine, told Healio. “Esophageal cancer is a particularly deadly disease, with a 5% 5-year survival rate for distant-stage disease. Throughout the pandemic, physicians across the country have been trying to balance the risks [for] esophageal cancer progression with the risks [for] COVID-19 infection. We conducted this study to assess the impact of delaying esophageal cancer care and thus inform this balancing act.”
Researchers gathered data from the National Cancer Database between 2010 and 2017 and used multivariable Cox proportional hazards modeling and propensity score-matched analysis to compare survival rates among patients with stage I esophageal cancer (median age, 65 years) who underwent early (n = 226) vs. delayed surgery (n = 316), and among patients with stage II to stage III esophageal cancer who underwent early (n = 1,236; median age, 62 years) vs. delayed surgery (n = 200; median age, 65 years).
The investigators defined early surgery as esophagectomy within zero to 4 weeks of diagnosis for those with stage I disease and within 9 to 17 weeks following timely chemoradiation for those with stage II to stage III disease. Delayed surgery occurred within 12 to 16 weeks for the stage I group and 21 to 29 weeks for the stage II to stage III group.
Key findings
Results showed comparable 5-year survival rates among patients with stage I to stage II disease who underwent early (65%; 95% CI, 55.2-73.2) vs. delayed surgery (65.1%; 95% CI, 55.6-73.1).
However, researchers observed an improvement in 5-year survival among patients with stage II to stage III disease who underwent early (41.6%; 95% CI, 32.1-50.8) vs. delayed surgery (22.9%; 95% CI, 14.9-31.8).
Implications
“All patients should receive timely surgery and this study should not be used to justify delays in treatment under any circumstance,” Bajaj told Healio. “That being said, as hospitals reintegrate services during the COVID-19 pandemic, and for other future pandemics, timely surgery for patients with stage II to stage III esophageal cancer should be prioritized whenever possible. In addition, these findings may provide reassurance for patients with stage I disease who had to delay care during the COVID-19 pandemic or for any number of personal reasons during nonpandemic times. The natural next steps to this research would be determining the impact of delayed treatment using pandemic-era data.”
References:
- Bajaj SS, et al. J Am Coll Surg. 2022;doi:10.1097/XCS. 0000000000000248.
- Delays in surgery for advanced esophageal cancer result in significantly worse survival than early surgery (press release). Available at: www.facs.org/for-medical-professionals/news-publications/news-and-articles/press-releases/2022/surgery-delays-esophageal-cancer/#. Published May 12, 2022. Accessed July 31, 2022.
For more information
Simar S. Bajaj can be reached at simarbajaj@college.harvard.edu.
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