P1.209. Long-Term Survival Outcomes After Esophagectomy for Cancer in Australia

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Background Five-year overall survival following esophagectomy for esophageal cancer is infrequently reported at a national level. This study investigated the influence of hospital annual volume on long-term survival in patients with esophageal cancer treated with esophagectomy in Australia. Methods All elective esophagectomy patients admitted to ICU in Australian hospitals between 2017 and 2023 were identified from the Australia and New Zealand Intensive Care Society Adult Patient Database, linked to the National Death Index for mortality ascertainment. All-cause overall survival from date of hospital admission was assessed. The influence of hospital volume on survival was evaluated using Kaplan-Meier curves and multivariable Cox proportional hazards regression, adjusting for age, sex, hospital classification, and comorbidities. Hospital volume was categorised as low (1–5), medium-Low (6–11), medium-high (12–17), and high (≥18 esophagectomies per year). Results A total of 2985 patients were treated at 94 hospitals. The in-hospital mortality rate was 2.2% and five-year overall survival was 58.7% (95% CI 56.7-60.7%). No statistically significant difference in all-cause overall survival was observed across hospital annual volume categories (log-rank p=0.6); all pairwise comparisons were non-significant after Benjamini-Hochberg correction (all adjusted p≥0.70), and five-year survival estimates ranged from 57.1% to 60.9% across volume categories. On multivariable analysis, older age was also associated with increased mortality risk, while female sex was associated with 25% lower hazard of death. Conclusion Hospital volume did not predict long-term survival following esophagectomy for esophageal cancer in Australia. Other factors including patient characteristics, recurrence rates and tumour biology likely have a greater effect on the chances of long-term survival than hospital volume.