Article Text

Download PDFPDF

Surgery during holiday periods and prognosis in oesophageal cancer: a population-based nationwide Swedish cohort study
  1. Sheraz R Markar1,2,
  2. Karl Wahlin1,
  3. Fredrik Mattsson1,
  4. Pernilla Lagergren1,
  5. Jesper Lagergren1,3
  1. 1Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
  2. 2Department of Surgery & Cancer, Imperial College London, London, UK
  3. 3Division of Cancer Studies, King's College London, and Guy's and St Thomas’ NHS Foundation Trust, London, UK
  1. Correspondence to Dr Sheraz R Markar; s.markar{at}


Objective Previous studies indicate an increased short-term and long-term mortality from major cancer surgery performed towards the end of the working week or during the weekend. We hypothesised that the prognosis after major cancer surgery is also negatively influenced by surgery conducted during holiday periods.

Setting Population-based nationwide Swedish cohort study.

Participants Patients undergoing oesophagectomy for oesophageal cancer between 1987 and 2010. Among 1820 included patients, 206 (11.3%) and 373 (20.5%) patients were operated on during narrow and wide holiday periods, respectively.

Interventions Narrow (7 weeks) and wide (14 weeks) Swedish holiday periods.

Primary and secondary outcome measures 90-day all-cause, 5-year all-cause and 5-year disease-specific mortality.

Results Narrow holiday period did not increase all-cause 90-day (HR=0.84, 95% CI 0.53 to 1.33), all-cause 5-year (HR=1.01, 95% CI 0.85 to 1.21) or disease-specific 5-year mortality (HR=1.04, 95% CI 0.87 to 1.26). Similarly, wide holiday period did not increase the risk of 90-day (HR=0.79, 95% CI 0.55 to 1.13), all-cause 5-year (HR=0.96, 95% CI 0.84 to 1.1) or disease-specific 5-year mortality (HR=1.03, 95% CI 0.89 to 1.19).

Conclusions No measurable effects of holiday periods on short-term or longer term mortality following surgery for oesophageal cancer were observed in this population-based study, indicating that an adequate surgical experience was maintained during holiday periods.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.