Trends in distal esophageal and gastroesophageal junction cancer care: the Dutch nationwide IVORY study

Kalff, M.C.; Henegouwen, M.I.V.; Baas, P.C.; Bahadoer, R.R.; Belt, E.J.T.; Brattinga, B.; ... ; Gisbertz, S.S. (2023)

Article / Letter to editor

Objective:This study evaluated the nationwide trends in care and accompanied postoperative outcomes for patients with distal esophageal and gastro-esophageal junction cancer. Summary of Background Data:The introduction of transthoracic esophagectomy, minimally invasive surgery, and neo-adjuvant chemo(radio)therapy changed care for patients with esophageal cancer. Methods:Patients after elective transthoracic and transhiatal esophagectomy for distal esophageal or gastroesophageal junction carcinoma in the Netherlands between 2007-2016 were included. The primary aim was to evaluate trends in both care and postoperative outcomes for the included patients. Additionally, postoperative outcomes after transthoracic and tran-shiatal esophagectomy were compared, stratified by time periods. Results:Among 4712 patients included, 74% had distal esophageal tumors and 87% had adenocarcinomas. Between 2007 and 2016, the proportion of transthoracic esophagectomy increased from 41% to 81%, and neo-adjuvant treatment and minimally invasive esophagectomy increased from 31% to 96%, and from 7% to 80%, respectively. Over this 10-year period, postoperative outcomes improved: postoperative morbidity decreased from 66.6% to 61.8% (P = 0.001), R0 resection rate increased from 90.0% to 96.5% (P <0.001), median lymph node harvest increased from 15 to 19 (P <0.001), and median survival increased from 35 to 41 months (P = 0.027). Conclusion:In this nationwide cohort, a transition towards more neo-adju-vant treatment, transthoracic esophagectomy and minimally invasive surgery was observed over a 10-year period, accompanied by decreased postoperative morbidity, improved surgical radicality and lymph node harvest, and improved survival.

• complications
• esophageal cancer
• esophagectomy
• minimally invasive surgery
• neo-adjuvant treatment
• survival

• All authors: Kalff, M.C.; Henegouwen, M.I.V.; Baas, P.C.; Bahadoer, R.R.; Belt, E.J.T.; Brattinga, B.; Claassen, L.; Cosovic, A.; Crull, D.; Daams, F.; Dalsen, A.D. van; Dekker, J.W.T.; Det, M.J. van; Drost, M.; Duijvendijk, P. van; Eshuis, W.J.; Esser, S. van; Gaspersz, M.P.; Görgec, B.; Groenendijk, R.P.R.; Hartgrink, H.H.; Harst, E. van der; Haveman, J.W.; Heisterkamp, J.; Hillegersberg, R. van; Kelder, W.; Kingma, B.F.; Koemans, W.J.; Kouwenhoven, E.A.; Lagarde, S.M.; Lecot, F.; Linden, P.P. van der; Luyer, M.D.P.; Nieuwenhuijzen, G.A.P.; Olthof, P.B.; Peet, D.L. van der; Pierie, J.P.E.N.; Pierik, E.G.J.M.R.; Plat, V.D.; Polat, F.; Rosman, C.; Ruurda, J.P.; Sandick, J.W. van; Scheer, R.; Slootmans, C.A.M.; Sosef, M.N.; Sosef, O.; Steur, W.O. de; Stockmann, H.B.A.C.; Stoop, F.J.; Voeten, D.M.; Vugts, G.; Vijgen, G.H.E.J.; Weeda, V.B.; Wiezer, M.J.; Oijen, M.G.H. van; Gisbertz, S.S.
• Date: 2023-04-01
• Journal: Annals of Surgery
• Volume: 277
• Issue: 4
• Pages: 619 - 628
• DOI: doi:10.1097/SLA.0000000000005292
• Link: https://journals.lww.com/annalsofsurgery/fulltext/2023/04000/trends_in_d...