Abstract
INTRODUCTION: Cancer remains the leading cause of death worldwide, with esophageal cancer being the sixth leading cause of cancer-related deaths. For individuals with esophageal cancer, esophagectomy is the most effective treatment option available and has a high risk of both death and morbidity. Moreover, despite advances in preoperative optimization, surgery, and anesthesia techniques as well as the introduction of neoadjuvant therapy, the mortality and morbidity associated with esophagectomy remain high. OBJECTIVE: To assess the survival status and predictors of postoperative survival in patients who underwent esophageal surgery for esophageal malignancies at selected hospitals from to 2018-2023 in Ethiopia, Addis Ababa. METHODS: This was a retrospective cohort study. After acquiring data from the chart review, the data were analyzed using R version 4.3.3. Descriptive statistics for categorical variables were reported as frequencies and percentages. Kaplan-Meier curves and log-rank tests were used to estimate the survival curve and the difference in survival among groups within each covariate. After esophageal surgery, the impact of each covariate on time to death was assessed using the Cox proportional hazard model. RESULTS: One hundred eighty-three patients who underwent esophageal surgeries for esophageal malignancy at four governmental hospitals in Addis Ababa over 5 years were included. The mean age was 53.8 years. 120 (65.6 %) had a tumor size <3.3 cm, and squamous cell carcinoma accounted for 154 (84.2 %) cases. Epidural analgesia was the most commonly used analgesic technique, 40 (21.9 %). The 30-day mortality was 10.9 %. The overall 1-, 2-, 3-, 4-, and 5-year survival rates were 53 %, 30.6 %, 19.5 %, 19.5 %, and 13 %, respectively. The median survival was 17 months. ASA score of > III (AHR = 2.14, 95 % CI: 1.12-4.12), cervical anastomotic leak (AHR = 3.29, 95 % CI: 1.44-7.52), and sepsis (AHR = 3.70, 95 % CI: 1.46-9.38) were identified as predictors of postoperative mortality in the multivariate Cox regression model. CONCLUSION: In Ethiopia, patients who underwent surgery for esophageal cancer had low 5-year survival rates.