373. THE PROGNOSTIC IMPACT OF TIME DELAYS IN OESOPHAGEAL CANCER SURGERY: 10-YEAR EXPERIENCE OF A HIGH-VOLUME CENTRE
Richard Mcgregor, Matteo Magnoli, Judith Sayers, Graeme Couper, Chris Deans, Peter Lamb, Richard Skipworth- Gastroenterology
- General Medicine
Abstract
Background
Over the last twenty years, treatment of oesophageal cancer has changed towards a multimodal approach to achieve better clinical outcomes. Detailed staging paradigms and neoadjuvant treatment have resulted in a longer time period before oesophagectomy, but literature on the prognostic impact of longer waiting times is scarce in this field. The aim of this study was to determine whether hospital (HD) or time to surgery (TTSD) delays adversely impact patient outcomes.
Methods
All patients who underwent oesophagectomy for oesophageal cancer between January 2009 and February 2020 at the Royal Infirmary of Edinburgh (RIE) were identified from a prospectively maintained database.
Two different time delays were considered. Hospital delay, defined as the time between date of diagnosis and start of treatment (i.e. neoadjuvant chemotherapy or straight to surgery). Time to surgery delay (time between the end of neoadjuvant regimen and surgery). The primary endpoint was to investigate whether hospital or time to surgery delay affected overall survival (OS). Secondary endpoints anaylsed whether hospital or time to surgery delays affected post-operative complication rate, 30 day mortality, or disease-free survival (DFS).
Results
A total of 512 patients were included for analysis over the 10 year study period. ‘Delayed treatment’ (DT) was calculated as greater than the median ‘hospital delay’, which was 56 days. ‘Early treatment’ (ET) was therefore defined as <56 days. Similarly, median time to surgery was 35 days, and delay in time to surgery (DTTS) was defined as ≥35 days.
Kaplan–Meier survival analysis and the log rank tests did not find any significant difference in OS, DFS, post-operative complications, or 30 day mortality with either time delay. Further multivariate analyses showed that hospital and time to surgery delay, were not independent prognostic variables.
Conclusion
In our study group a hospital delay longer than 8 weeks did not impact on OS, DFS, or post-operative complications. Moreover, a time to surgery delay over 5 weeks appears safe, and did not impact overall survival.