Lagergren Jesper, Mattsson Fredrik, Lagergren Pernilla
*Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden†Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK‡Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Ann Surg. 2016 Jun;263(6):1133-7. doi: 10.1097/SLA.0000000000001324.
To assess whether weekday of surgery influences long-term survival in esophageal cancer.
Increased 30-day mortality rates have been reported in patients undergoing elective surgery later compared with earlier in the week.
This population-based cohort study included 98% of all esophageal cancer patients who underwent elective surgery in Sweden in 1987 to 2010, with follow-up until 2014. The association between weekday of surgery and 5-year all-cause and disease-specific mortality was analyzed using a multivariable Cox proportional hazards model, providing hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, comorbidity, tumor stage, histology, neoadjuvant therapy, and surgeon volume.
Among 1748 included patients, surgery conducted from Wednesday to Friday entailed 13% increased all-cause 5-year mortality compared with surgery conducted from Monday to Tuesday (HR = 1.13, 95% CI, 1.01-1.26). The corresponding association was strong for early tumor stages (0-I) (HR = 1.59, 95% CI, 1.17-2.16), moderate for intermediate tumor stage (II) (HR = 1.28, 95% CI, 1.07-1.53), and absent in advanced tumor stages (III-IV) (HR = 0.93, 95% CI, 0.79-1.09). The increase in 5-year mortality for each later weekday (discrete variable) was 7% for all tumor stages (HR = 1.07, 95% CI, 1.02-1.12), 24% for early tumor stages (HR = 1.24, 95% CI, 1.09-1.41), 13% for intermediate stage (HR = 1.13, 95% CI, 1.05-1.22), whereas no increase was found for advanced stages (HR = 0.98, 95% CI, 0.92-1.05). The disease-specific 5-year mortality was similar to the all-cause mortality.
The increased 5-year mortality of potentially curable esophageal cancer after surgery later in the week suggests that this surgery is better carried out earlier in the week.
评估手术的工作日是否会影响食管癌患者的长期生存率。
据报道，择期手术安排在本周晚些时候的患者30天死亡率高于本周早些时候。
这项基于人群的队列研究纳入了1987年至2010年在瑞典接受择期手术的所有食管癌患者的98%，随访至2014年。使用多变量Cox比例风险模型分析手术工作日与5年全因死亡率和疾病特异性死亡率之间的关联，提供风险比（HRs）及95%置信区间（CIs），并对年龄、合并症、肿瘤分期、组织学、新辅助治疗和外科医生手术量进行了调整。
在纳入研究的1748例患者中，与周一至周二进行的手术相比，周三至周五进行的手术全因5年死亡率增加了13%（HR = 1.13，95%CI，1.01 - 1.26）。这种关联在早期肿瘤阶段（0 - I期）较强（HR = 1.59，95%CI，1.17 - 2.16），在中期肿瘤阶段（II期）中等（HR = 1.28，95%CI，1.07 - 1.53），而在晚期肿瘤阶段（III - IV期）不存在（HR = 0.93，95%CI，0.79 - 1.09）。每个较晚工作日（离散变量）的5年死亡率增加情况为：所有肿瘤阶段为7%（HR = 1.07，95%CI，1.02 - 1.12），早期肿瘤阶段为24%（HR = 1.24，95%CI，1.09 - 1.41），中期阶段为13%（HR = 1.13，95%CI，1.05 - 1.22），而晚期阶段未发现增加（HR = 0.98，95%CI，0.92 - 1.05）。疾病特异性5年死亡率与全因死亡率相似。
本周晚些时候进行手术的潜在可治愈食管癌患者5年死亡率增加，表明该手术最好在本周早些时候进行。
