Auditing the Patients Outcomes After Surgery for Esophageal and Gastric Cardia Cancer Within the 18 Years Period. Single Center Experience

Abstract Background Malignant tumor of the esophagus and gastroesophageal junction is a long-term survival limiting disease. Although over the years there has been a significant shift in the quality of surgical care, oncological approach and treatment protocols, despite it is still disease with a very poor prognosis. Methods Evaluation of a retrospective database of consecutive patients at our surgical departement from 2005 to 2022. We divided these 18 years into three periods A (2005 – 2010), B (2011 – 2016) and C (2017 – 2022) in which we evaluated overall survival, morbidity, anastomotic complications, 30- and 90-day mortality and number of removed nodes. The difference in the number of patients with adneocarcinoma was between periods A and C, higher by almost 30%, squamous cell carcinoma without an increase. Results During the observed period, radical surgery was performed on 1252 patients, 881 patients with adenocarcinoma (70.37%) and 316 patients with squamous cell carcinoma (25.24%) and 4.39% (n=55) with another histological type. The period A N=384 (2005 – 2010), period B N=405 (2011 – 2016) and C N=463 (2017 – 2022). Between periods A and C, we recorded an increase in frequency of adenocarcinoma by almost 30%, squamous cell carcinoma without any increase. 62.3% of patients (N=780) underwent neoadjuvant oncological treatment. The indication for its performance was the clinical TNM classification (cT2 and more or cN+), histological type, general condition of the patient and as well patients age. We indicated for chemoradiotherapy 271 patients (21.65%), CHT 491 (39.22%) RT only in 17 patients and 472 (37.7%) patients designated for surgery without any other treatment. • 5-year survival in the entire group was 37.20% (Graph No 1) and median survival was 974 days for adenocarcinoma and 909 days for squamous cell carcinoma. • 30-day mortality for the entire monitored period was 1.92% (24 out of 1252) and 90-day mortality was 5.27% (66 out of 1252). • Other results are in the attached table. Conclusion During the observed period, it is clear that the quality indicators of surgical resection are improving, as well as the 30- and 90-day mortality, but this trend is not clearly manifested in the length of survival.