Surgical and Surgeon-Related Factors Related to Long-Term Survival in Esophageal Cancer: A Review

Abstract

Esophagectomy is the mainstay of curative treatment for most patients with a diagnosis of esophageal cancer. This procedure needs to be optimized to secure the best possible chance of cure for these patients. Research comparing various surgical approaches of esophagectomy generally has failed to identify any major differences in long-term prognosis. Comparisons between minimally invasive and open esophagectomy, transthoracic and transhiatal approaches, radical and moderate lymphadenectomy, and high and moderate hospital volume generally have provided only moderate alterations in long-term survival rates after adjustment for established prognostic factors. In contrast, some direct surgeon-related factors, which remain independent of known prognostic factors, seem to influence the long-term survival more strongly in esophageal cancer. Annual surgeon volume is strongly prognostic, and recent studies have suggested the existence of long surgeon proficiency gain curves for achievement of stable 5-year survival rates and possibly also a prognostic influence of surgeon age and weekday of surgery. The available literature indicates a potentially more critical role of the individual surgeon’s skills than that of variations in surgical approach for optimizing the long-term survival after esophagectomy for esophageal cancer. This finding points to the value of paying more attention to how the skills of the individual esophageal cancer surgeon can best be achieved and maintained. Careful selection and evaluation of the most suitable candidates, appropriate and structured training programs, and regular peer-review assessments of experienced surgeons may be helpful in this respect.

Epigenetic Regulator KDM4D Restricts Tumorigenesis via Modulating SYVN1/HMGB1 Ubiquitination Axis in Esophageal Squamous Cell Carcinoma

“…However, many patients may have no chances to have the surgical treatment for the advanced stages. In recent years, the developed systemic therapies have improved the outcomes, but the 5-year overall survival (OS) rate of ESCC still remains at 15%-25%, caused by distal metastasis or resistance to chemotherapy like cisplatin (10)(11)(12). As a result, there is an urgent need for exploring predictive biomarkers and effective therapeutic treatments to treat ESCC.…”

The “Weekday Effect”—Does It Impact Esophageal Cancer Surgery Outcomes?

“…[3,4,5] Surgery for esophageal cancer is complex, extensive and is associated with a learning curve [6]. Morbidity and mortality are more frequent after esophagectomy than most other oncological operations, and have been shown to be associated with hospital as well as surgeon volume [7]. The immediate post-operative period after esophagectomy is considered crucial and an important determinant of post-operative outcomes as well as prognosis [8].…”

Factors Influencing Survival Time in Patients Treated for Oesophageal Cancer with Palliative Intent in South Africa

“…The focus of research on prognostic factors in oesophageal cancer has been on factors affecting survival after curative treatment with many studies including both adenocarcinoma and squamous cell carcinoma subtypes in their analyses. [25,26] The studies analysing factors in patients with oesophageal squamous cell carcinoma (OSCC) only are mainly from Europe or Asia, with very little data available from…”