Delays in Surgery for Advanced Esophageal Cancer Result in Significantly Worse Survival Than Early Surgery

CHICAGO: Delays in surgery for esophageal cancer did not appear to have much impact on patients' relative survival for early-stage cancer compared with patients who had surgery early, but they did reduce the relative survival rate by almost half for patients with more advanced disease, according to an analysis of the National Cancer Database (NCDB).

The research is published as an "article in press" on the website of the Journal of the American College of Surgeons (JACS) and is one of the earliest studies to examine the impact of an extended three-month delay in esophagectomy for esophageal cancer.

The relative survival rate indicates whether a disease shortens one's life. It's a way to compare survival of those who have a specific disease with those who don't over a given period of time, typically five years from diagnosis date or the start of treatment for those with the disease, according to the National Cancer Institute.

"Timely care should always be the priority for patients," said senior author Chi-Fu Jeffrey Yang, MD, a thoracic surgeon at Massachusetts General Hospital in Boston and an assistant professor of surgery at Harvard Medical School. "However, there were times during the COVID-19 pandemic when delays to cancer care occurred.

This study, using pre-pandemic data, helps us understand the impact of the delay to care for patients with different stages of operable esophageal cancer."

Added lead author Simar Singh Bajaj, a student at Harvard and a researcher in the department of surgery at Mass General, "When we looked at early versus delayed surgery for patients with stage I cancer, patients in both groups had similar five-year survival rates.

However, for patients with stage II or III disease, delayed surgery was associated with worse survival when compared with early surgery." Stage II and III esophageal cancer is more advanced than Stage I.

"This finding is especially important as we're still working toward reintegrating services during the pandemic," Mr. Bajaj said. "We've seen a lot of delays in care as hospitals have been overwhelmed with COVID patients."