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TRENDS IN USE OF ESOPHAGECTOMY FOR ESOPHAGEAL ADENOCARCINOMA IN THE US
Francisco Schlottmann*1, Paula D. Strassle1, Fernando A. M. Herbella2, Arianna Barbetta3, Daniela Molena3, Marco G. Patti1
1 University of North Carolina, Chapel Hill, NC; 2Federal University of Sao Paulo, Sao Paulo, Brazil; 3Memorial Sloan Kettering Cancer Center, New York, NY
Background: The outcomes of patients with esophageal cancer is generally poor. However, esophagectomy remains the mainstay for curative treatment of esophageal cancer. Previous studies have suggested that surgical resection is severely underused.
Aims: We aimed to assess the trends in use of esophagectomy for patients with esophageal adenocarcinoma in the US.
Methods: A retrospective population-based analysis was performed using the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) Program registry for the period 2004-2014. Adult patients (≥18 years old) diagnosed with esophageal adenocarcinoma were eligible for inclusion. The yearly incidence of esophagectomy was calculated using Poisson regression. Inverse-probability of treatment weighted log-binomial regression was used to assess the effects of time on esophagectomy.
Results: A total of 21,301 patients were included, and 5,893 (27.7%) underwent esophagectomy. Between 2004 and 2014, the rate of esophagectomy significantly decreased from 30.3% to 25.2% (incidence rate ratio [IRR] 0.83, 95% confidence interval [CI] 0.74, 0.94, p=0.003). After accounting for patient and cancer characteristics, patients diagnosed in 2014 were 20% less likely to undergo esophagectomy compared to patients diagnosed in 2004 (RR 0.80, 95% CI 0.72, 0.90, p=0.0001) (Table 1).
Conclusion: The use of esophagectomy in patients with esophageal adenocarcinoma has significantly decreased in the last decade in the US. Since underutilization of surgical resection could have a negative impact on patient's survival, identifying causes of the decreased esophagectomy rates is imperative.
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