Clinical Corner - September 2022

During the coronavirus pandemic, national guidelines recommended that elective surgery be deferred when hospital resources are limited. The impact of this delay on outcomes of patients with cancer is unknown. A recent study evaluated the effect of delay of surgery for esophageal cancer during the period 2010-2017. Using the data from the National Cancer Database, to which our COC accredited registries contribute, the effect of surgical delay for esophageal cancer has recently been reported (Journal of the American College of Surgeons, August 2022).

An analysis of survival of patients with stage I esophageal cancer who received early (0 to 4 weeks after diagnosis) vs delayed esophagectomy (12 to 16 weeks) was performed. A similar review was undertaken of patients with stage II/III esophageal cancer who - after receiving timely chemoradiation (0 to 4 weeks after diagnosis) - underwent early (9 to 17 weeks) vs delayed esophagectomy (21 to 29 weeks).

The results showed that in patients with stage I cancer, early esophagectomy was associated with similar survival compared with delayed esophagectomy. For patients with stage II/III esophageal cancer, early esophagectomy was associated with improved survival relative to delayed esophagectomy. These are important findings which may eventually be found to exist in patients having delayed treatment during the COVID-19 pandemic.

The important message is that the time course from date of diagnosis to definitive treatment of patients collated by cancer registrars and included into cancer registries is critical to the analysis of these findings.