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Racial Disparities in Esophagectomy Procedures and Outcome for Esophageal Cancer
Adam P. Johnson*, Nathaniel R. Evans, Ernest L. Rosato, Karen Chojnacki, Charles J. Yeo, Scott W. Cowan
Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
Introduction: Recent studies demonstrate racial disparities in treatment and outcomes across a number of cancer diagnoses in the United States. According to the Surveillance, Epidemiology and End Results (SEER) Program (2006-2010), the racial distribution of esophageal cancer diagnoses is 83.4% white, 11.1% black, 4.4% Asian/Pacific Islander and 0.5% Native American/Alaskan.
Methods: We performed a retrospective review of esophageal resections for primary esophageal carcinoma using the 2005-2014 ACS NSQIP Participant Use File (PUF). Through chi-squared analysis, we compared the racial distribution of these resections to SEER reported esophageal carcinoma incidence, and evaluated the impact of race on occurrence of any morbidity, respiratory failure and mortality.
Results: ACS NSQIP PUF demonstrated 3,596 esophageal resections performed between 2005 and 2014. We found a significantly smaller proportion of resections in non-white races— only 2.7% black, 1.7% Asian/Pacific Islander and 0.3% Native American/Alaskan (p<0.001). We also found significantly higher overall morbidity (p=0.026), respiratory failure (p=0.001) and mortality (p<0.001) in non-white races (Figure).
Discussion: Racial disparities exist for esophageal resection of primary esophageal cancers not only for equity of care but also for perioperative outcomes. As we increase access through health care reform, continued investigation is necessary to identify and rectify barriers to safe and effective therapies for all patients.
 Figure 1: Complication Rates by Race for Esophageal Resections
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