Paulson and associates analyzed the SEER database to characterize the use of esophagectomy for patients with a diagnosis of esophageal cancer. Their findings suggest that, despite data establishing surgical resection as the treatment of choice for stage I disease, fewer patients than expected underwent esophagectomy, and these differences were particularly significant for nonwhite patients and those from regions with higher poverty rates. The nonoperative group included patients primarily treated with chemotherapy and/or radiotherapy and those who refused all treatment, so the meaning of the outcome comparisons is difficult to determine. It also seems likely that underuse rates are greater for the SEER population 65 years or older than they would be for all patients because of comorbidities.
Colson YL, Ashley SW. Underuse of Esophagectomy as Treatment for Resectable Esophageal Cancer—Invited Critique. Arch Surg. 2008;143(12):1203. doi:10.1001/archsurg.143.12.1203