Patient, Facility and Surgical Factors Associated with Significant Delays to Esophagectomy and Subsequent Poor Outcomes: An Analysis of 16,486 Cases.

Objective: Delays to definitive surgery in esophageal cancer may be associated with disease progression and worsened survival. The objective of this study was to perform a national assessment for predictors of delay to esophagectomy and to assess for their impact on oncologic and survival outcomes.
Methods: The National Cancer Database, 2010-2020, was queried for patients with locally advanced esophageal adenocarcinoma (Stage I-III). Patients were divided into upfront and post-neoadjuvant chemoradiation (nCRT) cohorts. The primary outcome was time-to-surgery. Time-to-surgery was examined as a continuous and categorical variable, where patients were divided into timely and delayed cohorts (96 days for upfront cohort; 56 days for post-nCRT cohort).
Results: Of 16,486 patients, 4,066 (24.7%) underwent upfront surgery and 12,420 (75.3%) post-nCRT surgery. In the upfront surgery group, median [interquartile range] time-to-surgery was 61 [40-96] days. Risk-adjusted predictors of delay included lack of insurance, lowest quartile of education, biopsy-based staging or surgical staging and robotic-assisted approach. In the post-nCRT cohort time-to-surgery was 55 [44-70] days. Risk-adjusted predictors of delay included Hispanic ethnicity, Medicaid or other government-based insurance, lowest quartile of educational status, and robotic approach. In the upfront surgery group, patients who had delayed surgery had increased odds of pathologic upstaging (1.31, 95% confidence interval 1.06-1.61). In the post-nCRT group, patients with surgical delay had increased odds of 90-day mortality (1.27, 95% confidence interval 1.06-1.51).
Conclusions: Following risk-adjustment for patient, oncologic, facility and surgical characteristics, there were several predictors of increased time to esophagectomy associated with consequences of upstaging and survival.
(Copyright © 2024. Published by Elsevier Inc.)