title: Delay in diagnostic workup and treatment of esophageal cancer.
abstract: BACKGROUND
  Esophageal cancer should preferably be detected and treated at an early stage, but this may be prohibited by late onset of symptoms and delays in referral, diagnostic workup, and treatment. The aim of this study was to investigate the impact of these delays on outcome in patients with esophageal cancer.
  
  
  METHODS
  For 491 patients undergoing esophagectomy for cancer between 1991 and 2007, patients' short- and long-term outcome were analyzed according to different time intervals between onset of symptoms, diagnosis, and surgical treatment.
  
  
  RESULTS
  Length of prehospital delay (from onset of symptoms until endoscopic diagnosis) did not affect patient's short- or long-term outcome. A shorter hospital delay between establishing the diagnosis of esophageal cancer on endoscopy and surgery was associated with lower overall morbidity and in-hospital mortality. Patients of ASA classes I and II experienced a shorter hospital delay than patients of ASA classes III and IV. Length of hospital delay between endoscopic diagnosis and surgery did not affect pathological tumor-node-metastasis stage or R0-resection rate. Longer hospital delay did not result in worse survival: Overall survival after esophagectomy for cancer was not significantly different between patients with hospital delay <5, 5-8, or >8 weeks (24.7%, 21.7%, and 32.3%, respectively; p = 0.12).
  
  
  CONCLUSIONS
  A longer hospital delay (between endoscopic diagnosis and surgery) resulted in worse patient's short-term outcome (higher overall morbidity and mortality rates) but not in a worse long-term outcome (overall survival). This may be explained by a more time-consuming diagnostic workup in patients with a poorer physical status and not by tumor progression.
authors.affiliation: Department of Surgery, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands. b.grotenhuis@erasmusmc.nl
authors.forename: Brechtje A
authors.initials: BA
authors.lastname: Grotenhuis
authors.forename: Pieter
authors.initials: P
authors.lastname: van Hagen
authors.forename: Bas P L
authors.initials: BP
authors.lastname: Wijnhoven
authors.forename: Manon C W
authors.initials: MC
authors.lastname: Spaander
authors.forename: Hugo W
authors.initials: HW
authors.lastname: Tilanus
authors.forename: Jan J B
authors.initials: JJ
authors.lastname: van Lanschot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001707:Biopsy, Needle; D015331:Cohort Studies; D057210:Delayed Diagnosis; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011336:Probability; D011379:Prognosis; D012017:Referral and Consultation / Q000639:trends; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome; D014850:Waiting Lists