Key result
Esophagectomy at centers with lowest perioperative morbidity is linked to improved long-term survival.
Why the study?
Current quality of care metrics after esophagectomy rely on short-term perioperative outcomes, but their relationship with long-term survival is unclear.
Does undergoing esophagectomy at centers with lower rates of major perioperative events improve long-term survival in patients with esophageal cancer?
Cohort
Yes
Does undergoing esophagectomy at centers with lower rates of major perioperative events improve long-term survival in patients with esophageal cancer?
Short-term perioperative metrics after esophagectomy can serve as indicators of long-term performance and oncologic efficacy.
Perioperative morbidity may proxy long-term center performance; leaves open confounding and selection bias in observational data.
Objective: Current metrics for quality of care after esophagectomy rely on short-term perioperative outcomes. We aimed to evaluate the relationship of perioperative outcomes and long-term survival after esophagectomy for esophageal cancer. Methods: Institutions in the National Cancer Database performing ≥20 esophagectomies (2010-2019) were ranked by a weighted composite score of major perioperative events-length of stay >20 days, unplanned readmissions, and 30-day mortality-and stratified into quintiles. Survival between centers with the least perioperative morbidity (quintile 1) and all other centers (quintiles 2-5) was compared using Kaplan-Meier, Cox proportional hazard, and landmark analyses. Conclusions: Our study demonstrates that patients undergoing esophagectomy for esophageal cancer at centers with lower rates of major perioperative events had improved long-term survival, suggesting that short-term metrics can serve as indicators of long-term performance and oncologic efficacy.
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Chang et al. (2026) conducted a cohort in esophageal cancer. Centers with the least perioperative morbidity (quintile 1) vs. All other centers (quintiles 2-5) was evaluated on long-term survival (p=.036). Undergoing esophagectomy at centers with the least perioperative morbidity was associated with improved long-term survival compared to other centers (P=0.036).
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