Palliative Surgery Outcomes for Patients with Esophageal Cancer: An National Cancer Database Analysis
| Autor: | Max R. Coffey, Katelynn C. Bachman, Philip A. Linden, Christopher W. Towe, Stephanie G. Worrell, Luis M. Argote-Greene |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Esophageal Neoplasms Kaplan-Meier Estimate Disease Palliative surgery 03 medical and health sciences 0302 clinical medicine medicine Chi-square test Humans Neoplasm Staging Proportional Hazards Models Retrospective Studies Relative survival Proportional hazards model business.industry General surgery Palliative Care Cancer Esophageal cancer medicine.disease Log-rank test Treatment Outcome 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Surgery business |
| Zdroj: | Journal of Surgical Research. 267:229-234 |
| ISSN: | 0022-4804 |
| DOI: | 10.1016/j.jss.2021.05.013 |
| Popis: | Introduction Many patients with esophageal cancer are not candidates for surgical resection with curative intent, given the advanced stage of disease at presentation. Palliative surgery is one treatment option, but relative survival of palliative surgery has not been described. This study aims to describe the outcomes of palliative surgery in patients with esophageal cancer. Methods We used the National Cancer Database to identify patients with esophageal cancer who received palliative surgery or non-surgical palliation—which consisted of palliative radiation and palliative chemotherapy without any surgery. The outcome of interest was overall survival. Characteristics of patients were compared between the palliative surgery group and the non-surgical group using rank sum test or chi square test. Survival differences between groups were compared using Kaplan Meier estimate and log rank test, and Cox proportional hazards model. Results A total of 14,589 patients were included in the analysis, including 2,812 (19.2%) receiving palliative surgery and 11,777 (80.7%) receiving non-surgical palliation (6,512 palliative radiation and 5,265 palliative chemotherapy). Median overall survival in palliative surgery patients was 5.5 mo, shorter than non-surgical palliation (6.4 mo, P = 0.004). However, when correcting for age, sex, nodal status, metastases, Charlson score, histology, academic center, and private insurance, there was no difference in survival between palliative surgery and non-surgical palliation in Cox proportional hazard modeling (HR 1.03 (0.975-1.090), P = 0.281). Conclusions Palliative surgery in advanced esophageal cancer is associated with poor overall survival but is similar to other palliative modalities. Palliative Surgery for esophageal cancer patients should be used sparingly given these poor outcomes. |
| Databáze: | OpenAIRE |
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