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. 2023 Apr 1;277(4):619-628.
doi: 10.1097/SLA.0000000000005292. Epub 2021 Nov 11.

Trends in Distal Esophageal and Gastroesophageal Junction Cancer Care: The Dutch Nationwide Ivory Study

Marianne C Kalff  1 , Mark I van Berge Henegouwen  1 , Peter C Baas  2 , Renu R Bahadoer  3 , Eric J T Belt  4 , Baukje Brattinga  5 , Linda Claassen  6 , Admira Ćosović  7 , David Crull  8 , Freek Daams  9 , Annette D van Dalsen  10 , Jan Willem T Dekker  11 , Marc J van Det  8 , Manon Drost  4 , Peter van Duijvendijk  6 , Wietse J Eshuis  1 , Stijn van Esser  11 , Marcia P Gaspersz  12 , Burak Görgec  13 , Richard P R Groenendijk  14 , Henk H Hartgrink  3 , Erwin van der Harst  13 , Jan Willem Haveman  7 , Joos Heisterkamp  15 , Richard van Hillegersberg  16 , Wendy Kelder  2 , B Feike Kingma  16 , Willem J Koemans  17 , Ewout A Kouwenhoven  8 , Sjoerd M Lagarde  18 , Frederik Lecot  19 , Philip P van der Linden  20 , Misha D P Luyer  21 , Grard A P Nieuwenhuijzen  21 , Pim B Olthof  11 , Donald L van der Peet  9 , Jean-Pierre E N Pierie  5 , E G J M Robert Pierik  10 , Victor D Plat  9 , Fatih Polat  22 , Camiel Rosman  23 , Jelle P Ruurda  16 , Johanna W van Sandick  17 , Rene Scheer  7 , Cettela A M Slootmans  23 , Meindert N Sosef  19 , Odin V Sosef  19 , Wobbe O de Steur  3 , Hein B A C Stockmann  12 , Fanny J Stoop  22 , Daan M Voeten  12 , Guusje Vugts  21 , Guy H E J Vijgen  18 , Víola B Weeda  4 , Marinus J Wiezer  20 , Martijn G H van Oijen  24 , Suzanne S Gisbertz  1
Affiliations

Trends in Distal Esophageal and Gastroesophageal Junction Cancer Care: The Dutch Nationwide Ivory Study

Marianne C Kalff et al. Ann Surg. .

Abstract

Objective: This study evaluated the nationwide trends in care and accompanied postoperative outcomes for patients with distal esophageal and gastro-esophageal junction cancer.

Summary of background data: The introduction of transthoracic esophagectomy, minimally invasive surgery, and neo-adjuvant chemo(radio)therapy changed care for patients with esophageal cancer.

Methods: Patients after elective transthoracic and transhiatal esophagectomy for distal esophageal or gastroesophageal junction carcinoma in the Netherlands between 2007-2016 were included. The primary aim was to evaluate trends in both care and postoperative outcomes for the included patients. Additionally, postoperative outcomes after transthoracic and tran-shiatal esophagectomy were compared, stratified by time periods.

Results: Among 4712 patients included, 74% had distal esophageal tumors and 87% had adenocarcinomas. Between 2007 and 2016, the proportion of transthoracic esophagectomy increased from 41% to 81%, and neo-adjuvant treatment and minimally invasive esophagectomy increased from 31% to 96%, and from 7% to 80%, respectively. Over this 10-year period, postoperative outcomes improved: postoperative morbidity decreased from 66.6% to 61.8% ( P = 0.001), R0 resection rate increased from 90.0% to 96.5% (P <0.001), median lymph node harvest increased from 15 to 19 ( P <0.001), and median survival increased from 35 to 41 months ( P = 0.027).

Conclusion: In this nationwide cohort, a transition towards more neo-adju-vant treatment, transthoracic esophagectomy and minimally invasive surgery was observed over a 10-year period, accompanied by decreased postoperative morbidity, improved surgical radicality and lymph node harvest, and improved survival.

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Conflict of interest statement

Luyer received research grants from Galvani and Medtronic. Nieuwenhuijzen reports consulting fees and research grants from Medtronic. Rosman has received research grants from Johnson&Johnson and Medtronic. van Berge Henegouwen reports research grants from Olympus and Stryker, in addition to consulting fees from Medtronic, Alesi Surgical, Johnson&Johnson and Mylan. van Oijen has received unrestricted research grants from Bayer, Lilly, Merck Serono, Nordic, Servier, and Roche. The remaining authors have no conflict of interest to report. No funding was received for this study.

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