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NESS 2006 Annual Meeting
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Anti-Reflux Surgery Reduces the Prevalence of Esophageal Cancer - A National Survey
Joshua S Hill, Liam A Haveran, James T McPhee, Frederick A Anderson, Demetrius E Litwin, Richard A Perugini
University of Massachusetts, Worcester, MA

Objective: The incidence of carcinoma of the esophagus is rising. While it has been suggested that surgical antireflux procedures are protective against esophageal cancer, this concept is not widely held to be true. Studies investigating the effect of antireflux surgery on the rate of esophageal cancer have suffered from low statistical power, due to the low incidence of esophageal cancer. There is variation in the regional application of antireflux surgery. We used the Nationwide Inpatient Sample, a large national survey, to investigate the correlation between anti-reflux procedure rates and the prevalence of esophageal cancer.
Design: Retrospective survey.
Setting: Hospital inpatients.
Patients: Nationwide Inpatient Sample (NIS), a representative all-payer database of non-federal hospitals in the United States (1998-2003).
Interventions: Anti-reflux procedures.
Main Outcome Measure: Regression of esophageal cancer prevalence by anti-reflux operative rates.
Results: Approximately 44.5 million hospital discharges from 1998 to 2003 were queried for the diagnosis of esophageal cancer (50,691 patient discharges) and anti-reflux procedures (47,448 patient discharges). Statewide estimates of the prevalence of esophageal cancer and the number of anti-reflux procedures performed were calculated; states were chosen as the subgroup for analysis since most patients cannot cross state lines for treatment due to insurance constraints. Esophageal cancer prevalence was inversely related to anti-reflux procedure rates (r-value -0.35). For every 10 patients who underwent an anti-reflux procedure, there was a decrease in esophageal cancer by 1.4 patients (p=0.03).
Conclusions: This cross-sectional study is the first to demonstrate an association between the prevalence of esophageal cancer and rate of anti-reflux procedures - suggesting that operative treatment of reflux may be protective in the development of esophageal cancer.


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