The influence of socioeconomic disadvantage on short‐ and long‐term outcomes after oesophagectomy for cancer: an Australian multicentre study

• Published in: ANZ journal of surgery Vol. 94; no. 10; pp. 1723 - 1731
• Main Authors: Park, Jin‐soo, Polikarpova, Aleksandra, Leibman, Steven, Laurence, Jerome M., Smith, Garett, Falk, Gregory L., Sandroussi, Charbel
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.10.2024; Blackwell Publishing Ltd
• Subjects: Aged; Australia - epidemiology; Cancer; complications; Disease-Free Survival; Esophageal cancer; Esophageal Neoplasms - mortality; Esophageal Neoplasms - surgery; Esophagectomy; Female; Health care facilities; Humans; Male; Middle Aged; Morbidity; Neoplasm Staging; oesophagectomy; Postoperative Complications - epidemiology; Retrospective Studies; Social Class; Socioeconomic Disparities in Health; Socioeconomic Factors; Socioeconomic status; Socioeconomics; surgical outcomes; Survival; Survival Rate; Treatment Outcome; Australia; complications; surgical outcomes; oesophagectomy; socioeconomic status
• DOI: 10.1111/ans.19172
• ISSN: 1445-1433; 1445-2197

Background Socioeconomic status (SES) affects outcomes following surgery for various cancers. There are currently no Australian studies that examine the role of socioeconomic disadvantage on outcomes following oesophagectomy for cancer. This study assessed whether SES was associated with short‐term perioperative morbidity, long‐term survival, and oncological outcomes following oesophagectomy across three tertiary oesophageal cancer centres in Australia. Methods A retrospective cohort study was performed comprising all patients who underwent oesophagectomy for cancer across three Australian centres. Patients were stratified into SES groups using the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD). Outcomes measured included perioperative complication rates, overall survival, and disease‐free survival. Results The study cohort was 462 patients, 205 in the lower SES and 257 in the higher SES groups. The lower SES group presented with more advanced oesophageal cancer stage, a higher rate of T3 (52.6% versus 42.7%, P = 0.038) and N2 disease (19.6% versus 10.5%, P = 0.006), and had a higher rate of readmission within 30 days (11.2% versus 5.4%, P = 0.023). There was no difference in overall survival or disease‐free survival between groups. Conclusion Lower socioeconomic status was associated with more advanced stage and increased risk of early, unplanned readmission following oesophagectomy, but was not associated with a difference in overall or disease‐free survival. The impact of socioeconomic status on oesophagectomy outcomes has not been studied in an Australian cohort. We examined 462 patients that underwent oesophagectomy for cancer across three institutions in New South Wales. Lower socioeconomic status was associated with more advanced stage and increased risk of early, unplanned readmission following oesophagectomy, but was not associated with a difference in overall or disease‐free survival.