Weekday of esophageal cancer surgery and its relation to prognosis

• In this nationwide Swedish study, later weekday of esophageal cancer surgery entailed increased long-term mortality, particularly for earlier tumor stages. The increase in 5-year mortality for each later weekday was 7% for all tumor stages, 24% for stages 0-I, 13% for stage II, but was not increased for stages III-IV. Objective: To assess whether weekday of surgery influences long-term survival in esophageal cancer. Summary Background Data: Increased 30-day mortality rates have been reported in patients undergoing elective surgery later compared to earlier in the week Methods: This population-based cohort study included 98% of all esophageal cancer patients who underwent elective surgery in Sweden in 1987-2010, 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, co-morbidity, tumor stage, histology, neoadjuvant therapy, and surgeon volume. Results: Among 1,748 included patients, surgery conducted Wednesday-Friday entailed 13% increased all-cause 5-year mortality compared to surgery Monday-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), while 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. Conclusions: The increased 5-year mortality of potentially curable esophageal cancer following surgery later in the week suggests that this surgery is better performed earlier in the week.

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