Trends in Distal Esophageal and Gastroesophageal Junction Cancer Care: The Dutch Nationwide Ivory Study

• Published in: Annals of surgery Vol. 277; no. 4; pp. 619 - 628
• Main Authors: Kalff, Marianne C., van Berge Henegouwen, Mark I., Baas, Peter C., Bahadoer, Renu R., Belt, Eric J. T., Brattinga, Baukje, Claassen, Linda, Ćosović, Admira, Crull, David, Daams, Freek, van Dalsen, Annette D., Dekker, Jan Willem T., van Det, Marc J., Drost, Manon, van Duijvendijk, Peter, Eshuis, Wietse J., van Esser, Stijn, Gaspersz, Marcia P., Görgec, Burak, Groenendijk, Richard P. R., Hartgrink, Henk H., van der Harst, Erwin, Haveman, Jan Willem, Heisterkamp, Joos, van Hillegersberg, Richard, Kelder, Wendy, Kingma, B. Feike, Koemans, Willem J., Kouwenhoven, Ewout A., Lagarde, Sjoerd M., Lecot, Frederik, van der Linden, Philip P., Luyer, Misha D. P., Nieuwenhuijzen, Grard A. P., Olthof, Pim B., van der Peet, Donald L., Pierie, Jean-Pierre E. N., Pierik, E. G. J. M. Robert, Plat, Victor D., Polat, Fatih, Rosman, Camiel, Ruurda, Jelle P., van Sandick, Johanna W., Scheer, Rene, Slootmans, Cettela A. M., Sosef, Meindert N., Sosef, Odin V., de Steur, Wobbe O., Stockmann, Hein B. A. C., Stoop, Fanny J., Voeten, Daan M., Vugts, Guusje, Vijgen, Guy H. E. J., Weeda, Víola B., Wiezer, Marinus J., van Oijen, Martijn G. H., Gisbertz, Suzanne S.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-04-2023
• Subjects: Adenocarcinoma - surgery; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Esophagogastric Junction - pathology; Esophagogastric Junction - surgery; Humans; Lymph Node Excision; Lymph Nodes - pathology; Postoperative Complications - etiology; Stomach Neoplasms - surgery; Treatment Outcome
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0000000000005292

This study evaluated the nationwide trends in care and accompanied postoperative outcomes for patients with distal esophageal and gastro-esophageal junction cancer.
The introduction of transthoracic esophagectomy, minimally invasive surgery, and neo-adjuvant chemo(radio)therapy changed care for patients with esophageal cancer.
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.
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).
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.