P1.070. Exploring the Association Between Month of Esophagectomy and Long-Term Survival Outcomes : a Large-Scale Survival Study Combined Questionnaire Survey Analysis

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Background Esophageal cancer remains a significant global health burden. While surgical and oncologic factors influencing survival after esophagectomy are well studied, the potential impact of surgical timing and medical staff burnout on long-term outcomes remains underexplored. This study investigates whether the month of esophagectomy and esophageal surgery personnel burnout affect survival in esophageal squamous cell carcinoma (ESCC). Methods A retrospective cohort of ESCC patients who underwent esophagectomy between January 2010 and December 2017 was analyzed from a single-center esophageal cancer case management database. Patients were stratified into twelve monthly subgroups based on the month of surgery. Survival outcomes were assessed using Kaplan–Meier analysis, Cox proportional hazards regression, and restricted mean survival time (RMST). Propensity score matching (PSM) was employed to adjust for confounding variables including age, sex, tumor stage, and neoadjuvant therapy. Additionally, a cross-sectional survey was conducted from 2024 to 2025 to evaluate burnout levels among 409 esophageal surgery professionals using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS), with monthly stratification to examine the temporal relationship between staff burnout patterns and surgical outcomes. Results Among 2,758 ESCC patients who underwent esophagectomy, those operated in February had the poorest survival, with a median survival time (MST) of 34.17 months compared to 45.23 months for non-February surgeries (HR: 0.833, 95% CI: 0.677–1.025, P=0.084). The 3- and 5-year overall survival rates were lower for February (47% and 36%) versus other months (56% and 45%). Conversely, April and June surgeries yielded superior outcomes (MST: 61.44 and 63.60 months, respectively). Burnout survey data (n=409) revealed a striking inverse pattern: February showed mild burnout (EE: 16.69, DP: 5.63), coinciding with the Chinese New Year holiday period, whereas non-February months demonstrated severe burnout (EE: 30.95, DP: 13.51). This paradoxical finding suggests that lower burnout alone does not predict better outcomes; rather, February’s reduced surgical volume and case complexity may be contributory factors. Conclusion Surgical timing, particularly esophagectomy performed in February, is associated with inferior long-term survival in ESCC patients. The concurrent low burnout levels during this period suggest that reduced surgical volume and altered case selection during the holiday season, rather than staff fatigue, may underlie this disparity. These findings highlight the importance of considering temporal factors in esophagectomy scheduling and warrant further multicenter validation.