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

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.