Weekday of surgery affects oesophageal cancer surgery prognosis

[PRESS RELEASE, 18 NOV. 2015] Patients who undergo surgery for oesophageal cancer early in the week – on a Monday or Tuesday – have a higher chance of long-term survival than those who have surgery at the end of the working week. This is according to a new study from Karolinska Institutet published in the scientific journal Annals of Surgery.

“The mechanism behind our results is still unknown,” says Jesper Lagergren, consultant and professor of surgery at Karolinska Institutet and King's College London. “But it’s possible that surgical precision to some extent declines towards the end of the week, due perhaps to the accumulated burden on the surgeon and his or her team.”

Oesophageal cancer surgery is time-consuming and exacting (taking on average six and a half hours), and it is a recognised fact that the experience of the surgeon has a substantial impact on the patient’s chance of survival. In the present study, the researchers examined a total of 1,748 patients operated on for oesophageal cancer in Sweden between 1987 and 2010, and found that five-year mortality was 13 per cent higher for patients who had undergone surgery on a Wednesday to a Friday than for those who had been operated on during a Monday or Tuesday; this after controlling for age, other diseases, stage and type of tumour (histology), pre-treatment with cytostatics and radiotherapy, and the surgeon’s experience of oesophageal cancer surgery.

The link between weekday of surgery and survival was strongest for early-stage tumours (0-I), moderate for medium-stage tumours (II) and non-existent for advanced-stage tumours (III-IV). The lack of effect for advanced tumours can be due to the generally low likelihood of being cured; the chances of surviving up to five years after the operation are about 10 per cent. With early-stage tumours, it is more the surgery that determines the outcome.

“More studies are needed to confirm these results, before anyone goes and issues clinical recommendations,” says Professor Lagergren. “But if these results end up being corroborated by future research, oesophageal cancer surgery should be planned to take place primarily at the beginning of the week.”

The research was financed by the Swedish Research Council and the Swedish Cancer Society.

Publication: 'Weekday of esophageal cancer surgery and its relation to prognosis', Jesper Lagergren, Fredrik Mattsson & Pernilla Lagergren, Annals of Surgery, online 10 November 2015, doi: 10.1097/SLA.0000000000001324.

More on Professor Lagergren’s research group

For further information, please contact:
Professor Jesper Lagergren, MD, PhD
Department of Molecular Medicine and Surgery, Karolinska Institutet
Tel: +44(0)8 517 760 12 or +44(0)70 227 40 88 
Email: jesper.lagergren@ki.se

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Karolinska Institutet is one of the world's leading medical universities. Its vision is to significantly contribute to the improvement of human health. Karolinska Institutet accounts for over 40 per cent of the medical academic research conducted in Sweden and offers the country´s broadest range of education in medicine and health sciences. The Nobel Assembly at Karolinska Institutet selects the Nobel laureates in Physiology or Medicine.