Longitudinal Follow-up of Medicare Patients after Esophageal Cancer Resection in the STS Database.

BACKGROUND

Understanding characteristics associated with survival following esophagectomy for cancer is critical to preoperative risk stratification. This study sought to define predictors for long-term survival following esophagectomy for cancer in Medicare patients.

METHODS

The STS GTSD was queried for patients age>65 who underwent esophagectomy for cancer between 2012-2020 and linked to CMS data using a deterministic matching algorithm. Patient, hospital, and treatment variables were assessed using a multivariable Cox proportional hazards model to evaluate characteristics associated with long-term mortality and readmission. Kaplan-Meier and cumulative incidence curves were generated and differences evaluated using the Log-rank test and Gray's test respectively.

RESULTS

After CMS linkage, 4,798 patients were included. 30-day and 90-day mortality in the study group was 3.84% and 7.45%, respectively. In the multivariable model, ASA>3, BMI>35, and diabetes were associated with increased mortality <90 days post-surgery, while pN/pT upstaging was associated with increased mortality >90 days post-surgery. Patients upstaged to pN(+) had a 147% increased mortality risk (aHR 2.47;95%CI2.02-3.02) and those that remained pN(+) a 75% increased mortality risk (aHR 1.75;95%CI1.57-1.95) compared to down-staged patients. Patients who were pT upstaged had a 109% (aHR 2.09;95%CI1.73-2.53) increased mortality risk compared to pT downstaged patients. Risk for readmission was independent of procedure type or approach and was higher in cStage>2, ASA>4, and pN+.

CONCLUSIONS

Medicare patients undergoing esophagectomy for cancer have identifiable patient-specific predictors for short-term mortality and tumor-specific predictors for long-term mortality and readmission. In the absence of pathologic T and N downstaging, risk for long-term mortality and readmission are increased.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.