Coronary SurgeryThursday, October 15, 2026

Where You Live and Where You Are Treated: Addressing Disparities in Esophageal Adenocarcinoma.

1 min read·By E. Nolan Beckett, MD·Source: Annals of surgical oncology

Key Numbers

38.2%

87.1% were treated at low

44.97%

40.62%

From The Cardiac Wire

The coronary story today is physiology, not grafts.

Continuous thermodilution in 51 patients with anomalous aortic origin of a coronary artery showed that the high-risk anatomic triad (intramural segment, acute take-off, slit-like ostium) produces measurably reduced hyperemic flow (179 vs 290 mL/min) and elevated microvascular resistance at rest and under stress.

Editor’s take pending for this article; this is the section commentary excerpt.

Source Abstract

BACKGROUND: Lower socioeconomic status conveys a known survival disadvantage for patients with esophageal adenocarcinoma (EAC). The potential role of the treating center volume in mitigating this disparity has not been described to date. METHODS: Non-metastatic EAC patients were identified (NCDB 2012-2021). High- and low-risk zip code groups were derived from income and education quartiles. Center volume was delineated as "low" or "high," with an annual threshold of ≥ 10 esophagectomies. Standard chi-square modeling, multivariable Cox hazard regression models, and Kaplan-Meier survival analyses were used where appropriate. RESULTS: Of 7462 EAC patients, 38.2% (n = 2849) resided in high-risk zip code areas, and 87.1% were treated at low-volume centers. Clinical (p = 0.230) and pathologic (p = 0.992) staging distribution did not differ across zip codes. High-volume centers saw a slightly increased proportion of advanced disease (p = 0.001). Patients at high-volume centers experienced better survival (5-year overall survival [5yOS], 44.97%) than their low-volume counterparts (5yOS, 40.62%) (p < 0.001). Patients residing in high-risk zip code areas demonstrated worse 5yOS than their low-risk counterparts (38.20% vs 43.74%; p < 0.001). Evaluation of low-volume centers showed that the high-risk zip code group had shorter survival than their low-risk counterparts (36.80% vs 43.21%; p < 0.001). Interestingly, in high-volume centers, survival across zip code groups was notably comparable (45.69% vs 46.20%; p = 0.80). CONCLUSIONS: Center expertise may offer an avenue for mitigating sociodemographic survival disparities in esophageal cancer. As discussions regarding centralized oncologic care continue, particular attention should be paid to the impact of high-volume center referral on the treatment of patients with social risk factors.

Authors: Campany ME, Kim S, Welton A, Linsky PL, Ha JS et al.

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