Department of Surgery, Amsterdam UMC Location Vrije Universiteit, de Boelelaan 1117, Amsterdam, the Netherlands; Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, the Netherlands.
Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, And Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden.
Eur J Surg Oncol. 2024 Feb;50(2):107318. doi: 10.1016/j.ejso.2023.107318. Epub 2023 Dec 12.
Rapid and complete workup of newly diagnosed esophageal cancer is vital for a timely, individual and high-quality treatment strategy. The aim of this study was to uncover potential delay, inefficiencies and non-contributing investigations in the diagnostic process in two tertiary referral centers.
This retrospective cohort study included all newly diagnosed esophageal cancer patients referred to or diagnosed in the Amsterdam UMC and Karolinska University Hospital between July 2020 and July 2021. Radiology, pathological assessment and multidisciplinary team meeting reports were reviewed. To assess time interval from diagnosis to treatment, dates of diagnosis, admittance to referral hospital, MDT meeting and start of treatment were collected.
In total, 252 esophageal cancer patients were included, 187 were treated with curative intent. Curatively treated patients had a mean age of 66 years, were predominantly male (74.9 %) with an adenocarcinoma (71.1 %). Curatively treated patients had a median time from diagnosis to referral of seven days (IQR:0-11) and of 35 days (IQR:28-45) between diagnosis and start of treatment. Main reasons for the significant (P < 0.001) differences in time between diagnosis and treatment between centers, Amsterdam UMC (39 days) vs Karolinska (27 days), were need for additional diagnostics (47.8 %) and differences in referral routine. Gastroscopy was repeated in 32.2 % of patients, mainly for further anatomical mapping.
Significant time differences between centers in the path from diagnosis to start treatment can be explained by differences in workup approach, referral routines and MDT meeting regulations. Repeat of gastroscopy can be prevented with clearer endoscopy guidelines.
快速、全面的新诊断食管癌检查对于及时、个体化和高质量的治疗策略至关重要。本研究旨在揭示在两家三级转诊中心的诊断过程中潜在的延迟、低效和非贡献性检查。
本回顾性队列研究纳入了 2020 年 7 月至 2021 年 7 月期间阿姆斯特丹 UMC 和卡罗林斯卡大学医院新诊断为食管癌的所有患者。回顾了放射学、病理评估和多学科团队会议报告。为了评估从诊断到治疗的时间间隔，收集了诊断日期、转诊医院入院日期、MDT 会议日期和治疗开始日期。
共纳入 252 例食管癌患者，187 例接受了根治性治疗。接受根治性治疗的患者平均年龄为 66 岁，主要为男性（74.9%），腺癌（71.1%）。根治性治疗患者从诊断到转诊的中位时间为 7 天（IQR：0-11），从诊断到治疗开始的中位时间为 35 天（IQR：28-45）。中心之间诊断和治疗之间时间差异显著（P<0.001）的主要原因是需要额外的诊断（47.8%）和转诊常规的差异。32.2%的患者重复进行了胃镜检查，主要是为了进一步进行解剖学绘图。
诊断到开始治疗的路径中，不同中心之间存在显著的时间差异，可以通过不同的检查方法、转诊常规和 MDT 会议规定来解释。通过更明确的内镜指南，可以避免重复进行胃镜检查。
