Skip to main content

Advertisement

SpringerLink
Log in

Factors associated with access and approach to esophagectomy for cancer: a National Cancer Database study

  • 2021 SAGES Poster
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Minimally invasive esophagectomy (MIE) for esophageal cancer has been associated with decreased pain, less blood loss, and shorter hospital stay with comparable survival to open surgery. To date, there is minimal information regarding what factors are associated with access to MIE.

Methods

The National Cancer Database (NCDB) was used to compare rates of MIE (either robotic or laparoscopic) and open esophagectomy (OE) by demographic and clinical factors. Continuous variables were compared using a linear trend test, and categorical variables were compared using Mantel–Haenszel tests. Binomial regression was performed to examine significant factors after adjusting for confounding variables.

Results

There were 18,366 patients included in the analysis. Of all esophagectomies performed in the US, 49% were performed by OE and 51% were performed by MIE. Patients who had undergone MIE were more likely to live in the Eastern US as compared with the Midwest [odds ratio (OR) 1.72; 95% confidence interval (CI) 1.58, 1.88] or the South (OR 1.31; 95% CI 1.19, 1.44). They were also more likely to be treated at an academic center (OR 1.64; 95% CI 1.53, 1.75) rather than a community hospital, and to be of White race as compared with Asian race (OR 1.46; 95% CI 1.10, 1.92). There was not a significant difference in the rates of MIE between White and Black patients (OR 1.12; 95% CI 0.96, 1.32). MIE was more likely with each passing year, and higher TNM stages of cancer were less likely to be treated with MIE (P < 0.001 for all).

Conclusion

While MIE is evolving, OE is still considered standard of care with robotic approaches representing a minority of MIE. While there are several factors associated with access to MIE, including race, facility type and geographic location, these factors should be further explored to help increase access to MIE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Barsouk A, Rawla P, Hadjinicolaou AV, Aluru JS, Barsouk A (2019) Targeted therapies and immunotherapies in the treatment of esophageal cancers. Med Sci 7(10):100. https://doi.org/10.3390/medsci7100100

    Article  CAS  Google Scholar 

  2. Wyant T, Alteri R, Kalidas M, Ogoro C, Lubejko B (2009) Esophageal cancer risk factors. American Cancer Society. https://www.cancer.org/cancer/esophagus-cancer/causes-risks-prevention/risk-factors.html. Accessed 26 Feb 2021

  3. Wyant T, Alteri R, Kalidas M, Ogoro C, Lubejko B (2021) Key statistics for esophageal cancer. American Cancer Society. https://www.cancer.org/cancer/esophagus-cancer/about/key-statistics.html. Accessed 26 Feb 2021

  4. Chai J, Jamal MM (2012) Esophageal malignancy: a growing concern. World J Gastroenterol 18(45):6521–6526. https://doi.org/10.3748/wjg.v18.i45.6521

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Malhotra GK, Yanala U, Ravipati A, Follet M, Vijayakumar M, Are CA (2017) Global trends in esophageal cancer. J Surg Oncol 115:564–579. https://doi.org/10.1002/jso.24592

    Article  PubMed  Google Scholar 

  6. Zhang H, Chen SH, Li YM (2004) Epidemiological investigation of esophageal carcinoma. World J Gastroenterol 10(12):1834–1835. https://doi.org/10.3748/wjg.v10.i12.1834

    Article  PubMed  PubMed Central  Google Scholar 

  7. Esophageal cancer—cancer stat facts. https://seer.cancer.gov/statfacts/html/esoph.html. Accessed 26 Feb 2021

  8. He H et al (2020) Trends in the incidence and survival of patients with esophageal cancer: a SEER database analysis. Thorac Cancer 11(5):1121–1128. https://doi.org/10.1111/1759-7714.13311

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kohler BA et al (2011) Annual report to the nation on the status of cancer, 1975–2007, featuring tumors of the brain and other nervous system. J Natl Cancer Inst 103(9):714–736. https://doi.org/10.1093/jnci/djr077

    Article  PubMed  PubMed Central  Google Scholar 

  10. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics, GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries”. CA Cancer J Clin. https://doi.org/10.3322/caac.21492

    Article  PubMed  Google Scholar 

  11. Klevebro F, Ekman S, Nilsson M (2017) Current trends in multimodality treatment of esophageal and gastroesophageal junction cancer—review article. Surg Oncol 26(3):290–295. https://doi.org/10.1016/j.suronc.2017.06.002

    Article  PubMed  Google Scholar 

  12. Barret M, Prat F (2018) Diagnosis and treatment of superficial esophageal cancer. Ann Gastroenterol 31(3):256–265. https://doi.org/10.20524/aog.2018.0252

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lazzarino AI, Nagpal K, Bottle A, Faiz O, Moorthy K, Aylin P (2010) Open versus minimally invasive esophagectomy: trends of utilization and associated outcomes in England. Ann Surg 252(2):292–298. https://doi.org/10.1097/SLA.0b013e3181dd4e8c

    Article  PubMed  Google Scholar 

  14. Mallipeddi MK, Onaitis MW (2014) The contemporary role of minimally invasive esophagectomy in esophageal cancer topical collection on gastrointestinal cancers. Curr Oncol Rep. https://doi.org/10.1007/s11912-013-0374-9

    Article  PubMed  Google Scholar 

  15. Biere SS et al (2011) Traditional invasive vs. minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial). BMC Surg 11:2. https://doi.org/10.1186/1471-2482-11-2

    Article  PubMed  PubMed Central  Google Scholar 

  16. Weksler B, Sullivan JL (2017) Survival after esophagectomy: a propensity-matched study of different surgical approaches. Ann Thorac Surg 104(4):1138–1146. https://doi.org/10.1016/j.athoracsur.2017.04.065

    Article  PubMed  Google Scholar 

  17. Lv L, Hu W, Ren Y, Wei X (2016) Minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a meta-analysis. OncoTargets Ther 9:6751–6762. https://doi.org/10.2147/OTT.S112105

    Article  Google Scholar 

  18. Straatman J et al (2017) Minimally invasive versus open esophageal resection. Ann Surg 266(2):232–236. https://doi.org/10.1097/SLA.0000000000002171

    Article  PubMed  Google Scholar 

  19. Smedley BD, Stith AY, Nelson AR (2003), Assessing potential sources of racial and ethnic disparities in care: patient- and system-level factors. https://www.ncbi.nlm.nih.gov/books/NBK220359/. Accessed 26 Feb 2021

  20. Dubecz A et al (2012) Temporal trends in long-term survival and cure rates in esophageal cancer: a SEER database analysis. J Thorac Oncol 7(2):443–447. https://doi.org/10.1097/JTO.0b013e3182397751

    Article  PubMed  Google Scholar 

  21. Sridhar P et al (2019) Esophageal cancer presentation, treatment, and outcomes vary with hospital safety-net burden. Ann Thorac Surg 107(5):1472–1479. https://doi.org/10.1016/j.athoracsur.2018.11.065

    Article  PubMed  Google Scholar 

  22. Baquet CR, Commiskey P, Mack K, Meltzer S, Mishra SI (2005) Esophageal cancer epidemiology in blacks and whites: racial and gender disparities in incidence, mortality, survival rates and histology. J Natl Med Assoc 97(11):1471–1478. www.seer.cancer.gov. Accessed 26 Feb 2021

  23. Savitch SL et al (2020) Racial disparities in rates of surgery for esophageal cancer: a study from the National Cancer Database. J Gastrointest Surg. https://doi.org/10.1007/s11605-020-04653-z

    Article  PubMed  Google Scholar 

  24. Wasif N et al (2018) Racial and socioeconomic differences in the use of high-volume commission on cancer-accredited hospitals for cancer surgery in the United States. Ann Surg Oncol 25(5):1116–1125. https://doi.org/10.1245/s10434-018-6374-0

    Article  PubMed  Google Scholar 

  25. Marsh HW (1998) Pairwise deletion for missing data in structural equation models: nonpositive definite matrices, parameter estimates, goodness of fit, and adjusted sample sizes. Struct Equ Model 5(1):22–36. https://doi.org/10.1080/10705519809540087

    Article  Google Scholar 

  26. Manigrasso M et al (2021) Robotic esophagectomy. A systematic review with meta-analysis of clinical outcomes. J Pers Med. https://doi.org/10.3390/JPM11070640

    Article  PubMed  PubMed Central  Google Scholar 

  27. Espinoza-Mercado F et al (2019) Does the approach matter? Comparing survival in robotic, minimally invasive, and open esophagectomies. Ann Thorac Surg. https://doi.org/10.1016/j.athoracsur.2018.08.039

    Article  PubMed  Google Scholar 

  28. Larson E, Andrilla C, Kearny J, Garberson L, Patterson D (2021) The distribution of the general surgery workforce in rural and urban American in 2019 Policy Brief 1–9. https://familymedicine.uw.edu/rhrc/wp-content/uploads/sites/4/2021/03/RHRC_PBMAR2021_LARSON.pdf. Accessed 14 July 2021

  29. Zhang X, Lin D, Pforsich H, Lin VW (2020) Physician workforce in the United States of America: forecasting nationwide shortages. Hum Resour Health. https://doi.org/10.1186/S12960-020-0448-3

    Article  PubMed  PubMed Central  Google Scholar 

  30. Revels SL, Morris AM, Reddy RM, Akateh C, Wong SL (2013) Racial disparities in esophageal cancer outcomes. Ann Surg Oncol 20(4):1136. https://doi.org/10.1245/S10434-012-2807-3

    Article  PubMed  Google Scholar 

  31. Chen Z et al (2017) Incidence and survival differences in esophageal cancer among ethnic groups in the United States. Oncotarget 8(29):47037. https://doi.org/10.18632/ONCOTARGET.16694

    Article  PubMed  PubMed Central  Google Scholar 

  32. Pickens A, Orringer MB (2003) Geographical distribution and racial disparity in esophageal cancer. Ann Thorac Surg 76(4):S1367–S1369

    Article  Google Scholar 

  33. Kubo A, Corley DA (2004) Marked multi-ethnic variation of esophageal and gastric cardia carcinomas within the United States. Am J Gastroenterol 99(4):582–588. https://doi.org/10.1111/j.1572-0241.2004.04131.x

    Article  PubMed  Google Scholar 

  34. Brusselaers N, Mattsson F, Lindblad M, Lagergren J (2015) Association between education level and prognosis after esophageal cancer surgery: a Swedish population-based cohort study. PLoS ONE 10(3):e0121928. https://doi.org/10.1371/journal.pone.0121928

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Schandl AR, Johar A, Mälberg K, Lagergren P (2018) Education level and health-related quality of life after oesophageal cancer surgery: a nationwide cohort study. BMJ Open 8(8):20702. https://doi.org/10.1136/bmjopen-2017-020702

    Article  Google Scholar 

  36. Lagergren J et al (2016) Marital status, education, and income in relation to the risk of esophageal and gastric cancer by histological type and site. Cancer 122(2):207–212. https://doi.org/10.1002/cncr.29731

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Kevin Kennedy for his statistical expertise in cross-checking analyses for accuracy.

NCDB Disclaimer

The CoC's NCDB and the hospitals participating in the CoC NCDB are the source of the de-identified data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

Funding

No funding was required for the study.

Author information

Authors and Affiliations

  1. Department of Surgery, Allegheny General Hospital, Pittsburgh, PA, 15212, USA

    Elizabeth Blears & James Shahoud

  2. Division of Thoracic and Esophageal Surgery, Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, Pittsburgh, PA, USA

    Hiran C. Fernando & Benny Weksler

  3. Department of Thoracic and Cardiovascular Surgery, Allegheny General Hospital, 320 E North Ave, South Tower, 14th FL, Pittsburgh, PA, 15212, USA

    Benny Weksler

Authors
  1. Elizabeth Blears
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiran C. Fernando
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James Shahoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Benny Weksler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benny Weksler.

Ethics declarations

Disclosures

Drs. Benny Weksler, Elizabeth Blears, Hiran Fernando and James Shahoud have no conflicts of interest or financial ties to disclose. Dr. Benny Weksler is a lecturer for AstraZeneca, but his lecture material does not directly overlap with this study. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Presented at SAGES 2021 Annual Meeting, Las Vegas, NV, 31 August–3 September.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Blears, E., Fernando, H.C., Shahoud, J. et al. Factors associated with access and approach to esophagectomy for cancer: a National Cancer Database study. Surg Endosc 36, 7016–7024 (2022). https://doi.org/10.1007/s00464-022-09032-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09032-0

Keywords

Search

Navigation