Association between Surgical Waiting Time and Postoperative Recurrence Risk in Clinical T1bN0M0 Thoracic Esophageal Squamous Cell Carcinoma: A Multicenter Retrospective Observational Study

BACKGROUND: Although prompt treatment is desirable for malignancies, surgical delays are sometimes unavoidable. Previous studies show conflicting results on the effect of diagnosis-to-surgery delay in esophageal cancer, mainly focusing on advanced stages treated preoperatively. Early stage disease, particularly cT1bN0, often involves longer waiting times, but the acceptable delay remains unclear. We conducted this study to evaluate the impact of surgical waiting time on postoperative survival in patients with clinical T1bN0M0 esophageal squamous cell carcinoma (ESCC) undergoing upfront esophagectomy. PATIENTS AND METHODS: This multicenter retrospective study included 160 patients with cT1bN0M0 ESCC undergoing subtotal esophagectomy with lymphadenectomy at seven Japanese institutions between 2008 and 2021. Receiver operating characteristic (ROC) analysis identified the optimal waiting time cutoff predicting recurrence. Survival outcomes were compared between short and long waiting groups using the Kaplan-Meier method and Cox regression analyses. RESULTS: ROC analysis identified 66.5 days as the optimal cutoff value. The long waiting group (≥ 67 days) showed significantly worse 3-year recurrence-free survival (87.9% versus 73.5%, log-rank P < 0.01; hazard ratio 2.71, 95% confidence interval 1.29-5.70, P < 0.01), whereas cancer-specific survival showed no significant difference. Multivariate analysis identified prolonged waiting time, pathological T2 or deeper invasion, and lymph node metastasis as independent predictors of recurrence, with longer delays linked to increased systemic recurrence beyond 2 years postoperatively. CONCLUSIONS: In patients with cT1bN0 ESCC, surgical delay beyond approximately 2 months independently increases postoperative recurrence. It is suggested that planning surgery without delay reduces the risk of recurrence; however, verification in a larger cohort is necessary.