Elsevier

Surgery

Volume 152, Issue 5, November 2012, Pages 903-910
Surgery

Original Communication
Population-based esophageal cancer survival after resection without neoadjuvant therapy: An update

https://doi.org/10.1016/j.surg.2012.03.025Get rights and content

Background

There are few population-based studies addressing the survival after resection for esophageal cancer. This study represents an update of a nationwide Swedish cohort initiated in 1987.

Methods

Based on data from the Swedish Patient Register, Swedish Cancer Register, and histopathologic records, 1,008 patients who had undergone esophageal resection as the only treatment for esophageal cancer were identified between January 1, 1987 and December 31, 2005. These were followed until death or emigration through linkage to the Swedish Total Population Register until January 1, 2009. Tumor stage, location, and histology were assessed from histopathologic reports, and comorbidities were assessed from the Patient Register. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) regarding survival. The results were adjusted for age, sex, comorbidity, tumor stage, location, histology, surgical radicality, and hospital volume.

Results

The proportion of patients surviving for 5 years increased from 19.7% in 1987-1991 to 30.7% in 1997-2000, but remained at 30.5% between 2001 and 2005. No difference in overall adjusted survival was found between the periods of 2001-2005 and 1997-2000 (adjusted HR, 0.89; 95% CI, 0.70–1.13). Thirty-day mortality decreased from 4.9% in 1997-2000 to 2.0% in 2001-2005, rendering an adjusted HR of 0.26 (95% CI, 0.08–0.87).

Conclusion

After adjusting for relevant prognostic factors, long-term population-based survival after resection for esophageal cancer was unchanged between 2001 and 2005 compared to 1997-2000, while the corresponding 30-day mortality improved.

Section snippets

Study design

The design of this nationwide Swedish, population-based, cohort study was presented in detail in our previous publication.6 In brief, patients with esophageal cancer were identified using the Swedish Cancer Register, which is 98% complete.9, 10 Data on surgical procedures, including type, date, and hospital, and data on comorbidities, were ascertained through the Swedish Patient Register by linkage with the patient's personal identity number.11 Two investigators (IR and KC) reviewed

Study subjects

Among 6,995 patients diagnosed with esophageal cancer in Sweden between 1987 and 2005, 1,481 (21%) underwent tumor resection. Of patients who underwent the operation, 422 (28%) were excluded because they had received neoadjuvant treatment, and 51 (3%) were excluded because data were missing. The remaining 1,008 patients made up the final esophageal cancer surgery cohort. The median age at operation was 67 years (range, 31–85), which did not differ between calendar periods of operation.

Discussion

The main finding of this population-based study is that long-term survival after esophageal cancer surgery has not improved since 2000; however, 30-day mortality after the operation has decreased during the same period.

Among the strengths of the current study are the population-based design that decreases selection bias, the completeness of follow-up, and the long observation time. Limitations include the lack of information regarding some surgical details, but the aim of the study was to

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Supported by The Swedish Research Council (SIMSAM) and the Swedish Cancer Society.

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