Trends and results of oesophageal cancer surgery in Finland between 2004 and 2014

OBJECTIVES: Few population-based studies reporting trends in oesophageal cancer surgery exist. The aim of this study was to assess the incidence of oesophageal cancer, changes in resection rates, patient demographics and short- and long-term outcomes of oesophagectomy at the population level in Finland. METHODS: All Finnish patients diagnosed with cancer of the oesophagus or gastrooesophageal junction between 1 January 2004 and 31 December 2014 identified from the nationwide registries were included. The follow-up ended on 31 December 2016. For evaluation of changes in demographics and treatment, data were divided into 2 periods: 2004-2009 and 2010-2014. For comparison of short-and long-term outcomes, adjustments for age, sex, comorbidity, tumour stage and histology were used. RESULTS: The number of diagnosed oesophageal cancers was 4266. Of these, 740 underwent oesophagectomy. Resection rate increased from 15.2% in 2004-2009 to 19.6% in 2010-2014. The median number of oesophagectomies in Finnish hospitals increased from 1.9 to 3.7 per hospital per year. At the same time, minimally invasive surgery became more common (6.3% vs 35.1%, P<0.0001) and a trend for increase in neoadjuvant treatment was observed (46.8% vs 53.8%, P=0.0582). The rate of type III anastomosis leaks and conduit necroses was 5.1% without differences in time periods. Three-year [52.4% vs 61.6%, adjusted hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.59-0.95] and 5-year survival (42.1% vs 56.5%, adjusted HR 0.70, 95% CI 0.57-0.87) improved. CONCLUSIONS: This nationwide population-based study demonstrates an increase in resection rate, use of neoadjuvant treatment and minimally invasive surgery together with an improvement in long-term outcome after oesophageal cancer surgery.