P1.070. Exploring the Association Between Month of Esophagectomy and Long-Term Survival Outcomes : a Large-Scale Survival Study Combined Questionnaire Survey Analysis
Surgical timing, particularly esophagectomy performed in February, is associated with inferior long-term survival in ESCC patients, and concurrent low burnout levels during this period suggest that reduced surgical volume and altered case selection during the holiday season, rather than staff fatigue, may underlie this disparity.
Abstract
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes
Esophageal cancer remains a significant global health burden. While surgical and oncologic factors influencing survival after esophagectomy are well studied, the potential impact of surgical timing and medical staff burnout on long-term outcomes remains underexplored. This study investigates whether the month of esophagectomy and esophageal surgery personnel burnout affect survival in esophageal squamous cell carcinoma (ESCC).
A retrospective cohort of ESCC patients who underwent esophagectomy between January 2010 and December 2017 was analyzed from a single-center esophageal cancer case management database. Patients were stratified into twelve monthly subgroups based on the month of surgery. Survival outcomes were assessed using Kaplan–Meier analysis, Cox proportional hazards regression, and restricted mean survival time (RMST). Propensity score matching (PSM) was employed to adjust for confounding variables including age, sex, tumor stage, and neoadjuvant therapy. Additionally, a cross-sectional survey was conducted from 2024 to 2025 to evaluate burnout levels among 409 esophageal surgery professionals using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS), with monthly stratification to examine the temporal relationship between staff burnout patterns and surgical outcomes.
Among 2,758 ESCC patients who underwent esophagectomy, those operated in February had the poorest survival, with a median survival time (MST) of 34.17 months compared to 45.23 months for non-February surgeries (HR: 0.833, 95% CI: 0.677–1.025, P=0.084). The 3- and 5-year overall survival rates were lower for February (47% and 36%) versus other months (56% and 45%). Conversely, April and June surgeries yielded superior outcomes (MST: 61.44 and 63.60 months, respectively). Burnout survey data (n=409) revealed a striking inverse pattern: February showed mild burnout (EE: 16.69, DP: 5.63), coinciding with the Chinese New Year holiday period, whereas non-February months demonstrated severe burnout (EE: 30.95, DP: 13.51). This paradoxical finding suggests that lower burnout alone does not predict better outcomes; rather, February’s reduced surgical volume and case complexity may be contributory factors.
Surgical timing, particularly esophagectomy performed in February, is associated with inferior long-term survival in ESCC patients. The concurrent low burnout levels during this period suggest that reduced surgical volume and altered case selection during the holiday season, rather than staff fatigue, may underlie this disparity. These findings highlight the importance of considering temporal factors in esophagectomy scheduling and warrant further multicenter validation.
It is suggested that preoperative frailty assessment to target prehabilitation strategies, inform risk assessment, and support shared decision making are critical for improving long-term survival in esophageal cancer patients.
Lye-Yeng Wong, Ernest Chan, Tyler Wilson et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Adjuvant and Neo-Adjuvant Therapies
The survival benefit of neoadjuvant therapy for esophageal squamous cell carcinoma (ESCC) remains controversial, as landmark trials were conducted predominantly in adenocarcinoma populations. This study evaluated the association between neoadjuvant therapy and long-term survival in a large international multicenter ESCC cohort using propensity score methods and multivariable Cox regression.
We retrospectively analyzed 2,449 patients with ESCC who underwent curative esophagectomy at five institutions across three countries (Japan, China, and South Korea) between 2008 and 2022. Patients receiving neoadjuvant therapy (n=941) were compared with a surgery-first cohort (n=880) after excluding 41 cases with inconsistent survival data. Propensity score matching (PSM) 1:1 was performed using nearest-neighbor matching (caliper=0.1 SD of logit propensity score) with exact matching on center, adjusting for sex, age, clinical T and N stage. Inverse probability of treatment weighting (IPTW) with trimming (1st–99th percentile) served as a sensitivity analysis. Center-stratified univariate and multivariable Cox proportional hazards regression were applied. Primary endpoints were overall survival (OS) and disease-free survival (DFS).
In analysis, neoadjuvant therapy appeared protective for OS (HR 0.60, 95% CI 0.48–0.75, p<0.001) while DFS was worse (HR 1.57, 95% CI 1.34–1.84, p<0.001). This discordant finding reversed after center-stratified Cox regression, revealing substantial confounding by center. Univariate analysis showed neoadjuvant therapy was associated with worse OS (HR 2.22, 95% CI 1.75–2.83, p<0.001) and DFS (HR 2.31, 95% CI 1.89–2.82, p<0.001). Multivariable analysis confirmed neoadjuvant therapy as an independent predictor of worse OS (HR 1.48, 95% CI 1.11–1.96, p=0.007) and DFS (HR 1.39, 95% CI 1.09–1.77, p=0.007). PSM yielded 255 pairs; after matching, neoadjuvant therapy was associated with worse OS (HR 1.56, 95% CI 1.05–2.30, p=0.027) and DFS (HR 1.60, 95% CI 1.18–2.19, p=0.003). IPTW sensitivity analysis yielded consistent results (OS: HR 2.21, 95% CI 1.74–2.82; DFS: HR 2.30, 95% CI 1.89–2.81; both p<0.001).
In this international multicenter analysis of 2,449 ESCC patients, neoadjuvant therapy was not associated with improved survival after esophagectomy and remained an independent predictor of worse OS and DFS across univariate, multivariable, PSM, and IPTW analyses. These findings underscore the critical importance of histology-specific evidence and support the urgent need for contemporary randomized controlled trials designed specifically for ESCC populations.
Si-miao Lu, Yi Zhu, Qiulin Shi et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes
Five-year overall survival following esophagectomy for esophageal cancer is infrequently reported at a national level. This study investigated the influence of hospital annual volume on long-term survival in patients with esophageal cancer treated with esophagectomy in Australia.
All elective esophagectomy patients admitted to ICU in Australian hospitals between 2017 and 2023 were identified from the Australia and New Zealand Intensive Care Society Adult Patient Database, linked to the National Death Index for mortality ascertainment. All-cause overall survival from date of hospital admission was assessed. The influence of hospital volume on survival was evaluated using Kaplan-Meier curves and multivariable Cox proportional hazards regression, adjusting for age, sex, hospital classification, and comorbidities. Hospital volume was categorised as low (1–5), medium-Low (6–11), medium-high (12–17), and high (≥18 esophagectomies per year).
A total of 2985 patients were treated at 94 hospitals. The in-hospital mortality rate was 2.2% and five-year overall survival was 58.7% (95% CI 56.7-60.7%). No statistically significant difference in all-cause overall survival was observed across hospital annual volume categories (log-rank p=0.6); all pairwise comparisons were non-significant after Benjamini-Hochberg correction (all adjusted p≥0.70), and five-year survival estimates ranged from 57.1% to 60.9% across volume categories. On multivariable analysis, older age was also associated with increased mortality risk, while female sex was associated with 25% lower hazard of death.
Hospital volume did not predict long-term survival following esophagectomy for esophageal cancer in Australia. Other factors including patient characteristics, recurrence rates and tumour biology likely have a greater effect on the chances of long-term survival than hospital volume.
J. Petric, Muktar Ahmed, Norma B. Bulamu et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes
Recurrent disease remains the leading cause of mortality following esophagectomy for esophageal carcinoma. While patterns of recurrence have been previously described, the prognostic impact of recurrence timing and site on post-recurrence survival (PRS) remains unclear. This study evaluated the impact of disease-free survival (DFS) duration and first recurrence site on PRS.
A multicentric retrospective cohort study was conducted including patients who experienced recurrence following esophagectomy with curative intent for esophageal carcinoma between 2012-2023. The association between DFS and PRS was modeled continuously on Cox regression and linearity was assessed using Martingale residuals.
Among 359 patients, 142 (39.6%) developed recurrence. Median follow-up was 40 months and median PRS was 12 months.
On Kaplan–Meier analysis, PRS differed by DFS category (<6, 6–24, and >24 months; p=0.022), with the longest survival observed among patients recurring >24 months after surgery (18.2% of patients; median PRS 19 months) (Figure 1A). When modeled continuously in Cox regression, each 6-month delay in DFS was associated with an 11% reduction in post-recurrence mortality (HR per 6 months 0.89, p=0.011) (Figure 1B).
Median PRS for isolated nodal recurrence (17.6% of patients) was 23 months and significantly longer than isolated local, isolated distant, or combined recurrences (p=0.003) (Figure 2). Isolated nodal recurrence was asymptomatic and detected at scheduled imaging in 22/25 (88%) patients.
After adjustment for preoperative and pathologic variables, DFS >24 months and isolated nodal recurrence independently predicted longer PRS (HR 0.49, p=0.005 and HR 0.44, p=0.003, respectively).
Among patients with recurrent esophageal carcinoma after esophagectomy, isolated nodal recurrence and DFS >24 months independently predicted prolonged PRS. These findings may help refine postoperative surveillance strategies and guide selection of patients most likely to benefit from salvage therapy.
Ofek Zemer, Ran Orgad, H. Merin et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes
With the aging of the global population, an increasing number of elderly patients undergo esophagectomy for esophageal cancer. Elderly populations exhibit considerable heterogeneity in overall health status due to differences in comorbidities. However, the factors influencing long-term outcomes after minimally invasive esophagectomy in this population have not been fully elucidated. This study aimed to identify prognostic factors associated with long-term survival in patients aged ≥75 years who underwent minimally invasive esophagectomy.
This retrospective study evaluated 110 patients aged ≥75 years who underwent minimally invasive esophagectomy (thoracoscopic or robot-assisted thoracoscopic esophagectomy) with lymph node dissection at Tohoku University Hospital in Sendai, Japan, between 2008 and 2021. Patients with pathological diagnoses other than squamous cell carcinoma or adenocarcinoma were excluded. Prognostic factors associated with overall survival, including patient, tumor, and surgical factors, were analyzed. Furthermore, the impact of these factors on esophageal cancer-specific mortality and non-cancer-related mortality was subsequently evaluated.
Postoperative pneumonia (p<0.01) and pathological non-R0 resection (p<0.001) were identified as independent predictors of worse overall survival after minimally invasive esophagectomy. Esophageal cancer-specific mortality did not differ significantly between patients with and without postoperative pneumonia (p=0.160). Relapse-free survival also did not differ significantly between the two groups (p=0.202). In contrast, non-esophageal cancer-related mortality was significantly higher in patients who developed postoperative pneumonia (p=0.018). Among non-esophageal cancer-related deaths, respiratory diseases were the predominant cause of death in the postoperative pneumonia group, accounting for 9 of 11 deaths (81.8%).
Reducing the incidence of postoperative pneumonia may be important for improving long-term outcomes after esophagectomy in elderly patients, particularly by decreasing non-cancer-related mortality. Careful preoperative risk assessment, strategies to minimize surgical morbidity, and structured postoperative rehabilitation with functional follow-up may contribute to improved long-term survival.
J. Takahashi, Y. Ozawa, Y. Taniyama et al.· Diseases of the esophagus· 0 citations
Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes
Our previous study suggested an association between metformin use and complete response rates in esophageal cancer patients undergoing neoadjuvant concurrent chemoradiotherapy (CCRT). This study aims to evaluate the impact of metformin use during neoadjuvant CCRT on overall survival (OS) and cancer-specific survival (CSS) in esophageal cancer patients undergoing surgery, using a nationwide database.
We utilized the National Health Insurance Research Database to analyze patients diagnosed with esophageal cancer between January 2010 and December 2022. The index date was defined as the initiation of neoadjuvant therapy, with follow-up extending until December 2022. After propensity score matching (PSM), Cox regression analyses were performed to identify risk factors for survival outcomes, including OS and CSS.
A total of 2,345 patients who underwent neoadjuvant CCRT followed by surgery were included, with 568 patients remaining after PSM. Metformin use was associated with a higher risk of all-cause mortality (HR: 1.28, 95% CI: 1.05–1.57, p = 0.014). The 5-year OS rates were 23.4% in the metformin group and 31.1% in the non-metformin group (p = 0.018). However, metformin use was not significantly associated with CSS, with 5-year CSS rates of 34.7% and 41.0% in the metformin and non-metformin groups, respectively (p = 0.140).
This is the first nationwide database analysis evaluating the impact of metformin use during CCRT on OS and CSS in esophageal cancer patients. Metformin use was associated with lower OS but did not significantly affect CSS. Further study should be needed.
T. Yun, C. Kang, Ji Hyeon Park et al.· Diseases of the esophagus· 0 citations
