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by Surgical Tribune

A new study found that the weekday of surgery influenced survival rates in oesophageal cancer. (Photograph: Icatnews/Shutterstock)

Dec 2, 2015 | EUROPE

Oesophageal cancer: Weekday of surgery affects survival prognosis

STOCKHOLM, Sweden: Oesophageal cancer is one of the deadliest cancers worldwide, ranking sixth in mortality among all cancers. A study from Karolinska Institutet has now found a surprising link that may be decisive for long-term survival rates in patients suffering from the disease: the weekday they undergo surgery.

In order to assess whether the weekday of surgery influences survival rates in oesophageal cancer, the researchers analysed data of 1,748 patients operated on the disease in Sweden between 1987 and 2010. The found that the five-year mortality rate was 13 per cent higher for patients who had undergone surgery on a Wednesday to a Friday than for those who had been operated on a Monday or Tuesday.

According to the researchers, the difference persisted after taking into account potentially influencing factors, such as age, other diseases, stage and type of tumour, pretreatment with cytostatics and radiotherapy, and the surgeon’s experience of oesophageal cancer surgery.

“The mechanism behind our results is still unknown,” said Prof. Jesper Lagergren from the Department of Molecular Medicine and Surgery at the university. “But it’s possible that surgical precision to some extent declines towards the end of the week, due perhaps to the accumulated burden on the surgeon and his or her team.”

Oesophageal cancer surgery is generally considered time-consuming and demanding, taking about 6.5 hours on average. In addition, it is a recognised fact among medical experts that the surgeon’s experience has a substantial impact on the patient’s chance of survival.

The link between weekday of surgery and survival was strongest for early-stage tumours (0–I), moderate for medium-stage tumours (II) and non-existent for advanced-stage tumours (III–IV). According to the researchers, the lack of effect for advanced tumours may be due to the generally low likelihood of being cured compared with early-stage tumours, for which surgery has a greater impact on long-term outcomes.

Further studies are needed to confirm the results before clinical recommendations can be issued, Lagergren said. However, if the results are corroborated, oesophageal cancer surgery should be planned to take place primarily at the beginning of the week, he concluded.

Statistics from Cancer Research UK show that oesophageal cancer is the sixth most common cause of cancer death worldwide, accounting for around 400,000 deaths in 2012 (5 per cent of all cancer-related deaths). Various studies have associated factors such as smoking, drinking of hot tea, red meat consumption, poor oral health, low intake of fresh fruit and vegetables, and low socio-economic status with a higher risk of developing the disease.

The results of the study were published online on 10 November in the Annals of Surgery journal in an article titled “Weekday of esophageal cancer surgery and its relation to prognosis”.

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