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Showing content from https://pubmed.ncbi.nlm.nih.gov/20012379/ below:

Delay in diagnostic workup and treatment of esophageal cancer

Comparative Study

doi: 10.1007/s11605-009-1109-y. Epub 2009 Dec 10. Delay in diagnostic workup and treatment of esophageal cancer

Affiliations

Affiliation

¹ Department of Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands. b.grotenhuis@erasmusmc.nl

PMID: 20012379
PMCID: PMC2820689
DOI: 10.1007/s11605-009-1109-y

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Comparative Study

Delay in diagnostic workup and treatment of esophageal cancer

Brechtje A Grotenhuis et al. J Gastrointest Surg. 2010 Mar.

doi: 10.1007/s11605-009-1109-y. Epub 2009 Dec 10. Affiliation

¹ Department of Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands. b.grotenhuis@erasmusmc.nl

PMID: 20012379
PMCID: PMC2820689
DOI: 10.1007/s11605-009-1109-y

Item in Clipboard

Abstract

Introduction: Esophageal cancer should preferably be detected and treated at an early stage, but this may be prohibited by late onset of symptoms and delays in referral, diagnostic workup, and treatment. The aim of this study was to investigate the impact of these delays on outcome in patients with esophageal cancer.

Methods: For 491 patients undergoing esophagectomy for cancer between 1991 and 2007, patients' short- and long-term outcome were analyzed according to different time intervals between onset of symptoms, diagnosis, and surgical treatment.

Results: Length of prehospital delay (from onset of symptoms until endoscopic diagnosis) did not affect patient's short- or long-term outcome. A shorter hospital delay between establishing the diagnosis of esophageal cancer on endoscopy and surgery was associated with lower overall morbidity and in-hospital mortality. Patients of ASA classes I and II experienced a shorter hospital delay than patients of ASA classes III and IV. Length of hospital delay between endoscopic diagnosis and surgery did not affect pathological tumor-node-metastasis stage or R0-resection rate. Longer hospital delay did not result in worse survival: Overall survival after esophagectomy for cancer was not significantly different between patients with hospital delay <5, 5-8, or >8 weeks (24.7%, 21.7%, and 32.3%, respectively; p = 0.12).

Conclusion: A longer hospital delay (between endoscopic diagnosis and surgery) resulted in worse patient's short-term outcome (higher overall morbidity and mortality rates) but not in a worse long-term outcome (overall survival). This may be explained by a more time-consuming diagnostic workup in patients with a poorer physical status and not by tumor progression.

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Figures
Figure 1

Analysis of prehospital and hospital…

Figure 1

Analysis of prehospital and hospital delays encountered by patients who underwent surgical resection…

Figure 1

Analysis of prehospital and hospital delays encountered by patients who underwent surgical resection for esophageal cancer in Erasmus MC.

Figure 2

Median hospital delay (in weeks)…

Figure 2

Median hospital delay (in weeks) between endoscopic diagnosis and surgery increased during the…

Figure 2

Median hospital delay (in weeks) between endoscopic diagnosis and surgery increased during the study period (1991–2007): 3.9 weeks in 1991 toward 10.9 weeks in 2007.

Figure 3

Overall 5-year survival for esophageal…

Figure 3

Overall 5-year survival for esophageal cancer patients appeared longer for patients with a…

Figure 3

Overall 5-year survival for esophageal cancer patients appeared longer for patients with a hospital delay between diagnosis on first endoscopy and surgery >8 weeks (N = 177) versus patients with a hospital delay <5 weeks (N = 128) or 5–8 weeks (N = 186), although this difference did not reach statistical significance (p = 0.12).