title: Prolonged postoperative length of stay is associated with poor overall survival after an esophagectomy for esophageal cancer.
abstract: BACKGROUND
  To investigate the impact of prolonged length of stay (LoS) on long-term mortality in patients who have undergone curative resection for esophageal cancer (EC).
  
  
  METHODS
  Between January 2001 and December 2009, patients who underwent an esophagectomy for EC at Fudan University Shanghai Cancer Center were enrolled in this study. We retrospectively analyzed the medical charts of all of the enrolled patients. To determine the effect of postoperative LoS on long-term survival, we separated the patients into three groups based on the lengths of their postoperative LoS, including an LoS of less than 2 weeks (Group 1, ≤2 W), an LoS between 2 and 3 weeks (Group 2, ≤3 W) and an LoS of more than 3 weeks (Group 3, >3 W). Perioperative and long-term outcomes were compared between the groups.
  
  
  RESULTS
  In total, 348 patients were included in this study. All of the patients underwent an esophagectomy with 3-field lymph node dissection (3FLND). The median postoperative hospital stay was 14 days (range: 8-153 days). Complications were observed in 123 patients (15.9% in Group 1 vs. 73.2% in Group 2 vs. 96.6% in Group 3, P<0.001). The median duration of follow-up was 39 months (range: 3-120 months). There were significant reductions in preventive adjuvant therapy (P=0.003) and postoperative salvage therapy (P<0.001) among the three groups. The 5-year survival rate was significantly different among the groups (43% vs. 36% vs. 29%, respectively, P=0.006). There was no difference in the 5-year disease-free survival rate among the three groups (23% vs. 21% vs. 19%, P=0.238).
  
  
  CONCLUSIONS
  Prolonged LoS was significantly associated with reduced rates of overall survival (OS). The insufficient administration of adjuvant therapy may partly account for these findings.
authors.affiliation: 1 Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Longfei
authors.initials: L
authors.lastname: Ma
authors.affiliation: 1 Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Jingpei
authors.initials: J
authors.lastname: Li
authors.affiliation: 1 Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Longlong
authors.initials: L
authors.lastname: Shao
authors.affiliation: 1 Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Lin
authors.affiliation: 1 Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China ; 3 Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
authors.forename: Jiaqing
authors.initials: J
authors.lastname: Xiang
keywords: Esophageal cancer (EC); length of stay (LoS); overall survival (OS); surgery