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Weekday of Esophageal Cancer Surgery and Its Relation to Prognosis

Lagergren, Jesper MD, PhD; Mattsson, Fredrik BSc; Lagergren, Pernilla PhD

doi: 10.1097/SLA.0000000000001324

Objective: To assess whether weekday of surgery influences long-term survival in esophageal cancer.

Background: Increased 30-day mortality rates have been reported in patients undergoing elective surgery later compared with earlier in the week.

Methods: This population-based cohort study included 98% of all esophageal cancer patients who underwent elective surgery in Sweden in 1987 to 2010, with follow-up until 2014. The association between weekday of surgery and 5-year all-cause and disease-specific mortality was analyzed using a multivariable Cox proportional hazards model, providing hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, comorbidity, tumor stage, histology, neoadjuvant therapy, and surgeon volume.

Results: Among 1748 included patients, surgery conducted from Wednesday to Friday entailed 13% increased all-cause 5-year mortality compared with surgery conducted from Monday to Tuesday (HR = 1.13, 95% CI, 1.01–1.26). The corresponding association was strong for early tumor stages (0–I) (HR = 1.59, 95% CI, 1.17–2.16), moderate for intermediate tumor stage (II) (HR = 1.28, 95% CI, 1.07–1.53), and absent in advanced tumor stages (III–IV) (HR = 0.93, 95% CI, 0.79–1.09). The increase in 5-year mortality for each later weekday (discrete variable) was 7% for all tumor stages (HR = 1.07, 95% CI, 1.02–1.12), 24% for early tumor stages (HR = 1.24, 95% CI, 1.09–1.41), 13% for intermediate stage (HR = 1.13, 95% CI, 1.05–1.22), whereas no increase was found for advanced stages (HR = 0.98, 95% CI, 0.92–1.05). The disease-specific 5-year mortality was similar to the all-cause mortality.

Conclusions: The increased 5-year mortality of potentially curable esophageal cancer after surgery later in the week suggests that this surgery is better carried out earlier in the week.

*Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

Section of Gastrointestinal Cancer, Division of Cancer Studies, King's College London, London, UK

Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.

Reprints: Jesper Lagergren, MD, PhD, Department of Molecular Medicine and Surgery, Karolinska Institutet, NS 67, 2nd Floor, 171 76 Stockholm, Sweden. E-mail:

Disclosure: Supported by the Swedish Research Council and the Swedish Cancer Society. These study sponsors had no role in the design of the study; the collection, analysis, or interpretation of the data; the writing of the manuscript; or the decision to submit the manuscript for publication. The authors declare no conflicts of interest.

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