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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
Annals of surgery, 04/2023, Volume: 277, Issue: 4Journal Article
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.
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