A Study on the Impact of Surgical Duration on Esophageal Cancer

Purpose: Faster surgery has been associated with better outcomes. In the present study, we aimed to determine whether surgical duration affected overall survival (OS) in patients undergoing esophagectomy. Additionally, we assessed factors that influence surgical duration. Patients and Methods: This single-center retrospective cohort study included 128 patients who underwent Ivor-Lewis esophagectomy by a single surgeon between 2005 and 2019. The Cox proportional hazard model was used to evaluate the association of OS with the following variables: surgical duration, neo-adjuvant chemotherapy, pathological grade of depth of tumor invasion, lymph node (LN) metastasis, body mass index (BMI), and cervical LN dissection. Additionally, factors associated with prolonged surgical duration were examined by logistic regression analysis. Results: Based on the multivariate analysis, surgical duration was not associated with OS [hazard ratio (HR), 1.065; 95% confidence interval (CI), 0.586-1.937; P = 0.837]. On the other hand, tumor invasion (HR, 2.901; 95% CI, 1.483-5.674; P = 0.002) and LN metastasis (HR, 2.338 2.403; 95% CI, 1.237-4.420 1.257-4.593; P = 0.009 0.008) significantly influenced OS. The assessment of variables affecting surgical duration showed that BMI had a significant effect on surgical duration (odds ratio, 2.790; 95% CI, 1.254-6.204, P = 0.012). Conclusion: According to the analysis of patients who underwent the same surgical approach by a single surgeon, surgical duration of esophagectomy for esophageal cancer was significantly influenced by BMI; however, surgical duration had no impact on patient survival. Keywords: esophagectomy, Ivor-Lewis approach, depth of tumor invasion, lymph node metastasis, body mass index, overall survival