Research report: Return‐To‐Work and Working Status After Surgery for Gastric and Esophageal Cancer: A Prospective Observational Study

The research, published in Annals of Gastroenterological Surgery, found that 124 of 158 analyzed patients, or 78.5 percent, were working at 18 months after surgery, a figure the investigators defined conservatively by counting anyone lost to follow-up, including those whose disease progressed or who died, as not working.

The study enrolled patients aged 20 years or older who were employed at the time of diagnosis and scheduled for curative surgery between September 2022 and March 2024 at eight community hospitals and one university hospital in Japan. Patients had clinical stage I to IVA disease under UICC-TNM criteria. The median age was 65.5 years, ranging from 37 to 84, and 152 patients, or 96.2 percent, achieved R0 resection, meaning no residual tumor was left behind. Roughly 30 percent of the cohort had pathological stage III or higher disease, and postoperative complications occurred in 45 patients, or 28.5 percent. More than 90 percent of operations were performed using minimally invasive techniques.

Fifty-five patients, or 34.8 percent, were self-employed, 54, or 34.2 percent, were regular employees, and 96, or 60.8 percent, worked in companies or offices with 50 or fewer employees. Seven patients, or 4.4 percent, had already retired preoperatively. Questionnaires were administered at enrollment and at 6, 12, and 18 months after surgery, capturing working status, employment type, retirement experience, and the European Organization for Research and Treatment of Cancer QLQ-C30 quality-of-life instrument. Working status was defined as having worked at least 1 hour during the preceding week at each survey, and the 18-month time point was chosen deliberately to capture sustainable work participation beyond the typical one-year span of adjuvant chemotherapy, which the authors describe as a major barrier to resuming work.

Using the Kaplan-Meier method, the median time from surgery to first return to work was 30 days, with an interquartile range of 18 to 69 days, for gastric cancer, and 70 days, with an interquartile range of 38 to 143 days, for esophageal cancer. During follow-up, 99 patients with gastric cancer, or 89.2 percent, and 43 with esophageal cancer, or 91.5 percent, returned to work at least once. Because disease worsening or death could prevent a return to work, the investigators used a competing-risks approach with cumulative incidence functions and Fine-Gray regression, treating disease progression or death as competing events rather than ordinary censoring.

Sensitivity analyses using alternative definitions of time zero, including the start of treatment or the last working date, confirmed the associations for esophageal cancer and advanced stage, while the findings for female sex and preoperative retirement were directionally consistent but less robust. The authors suggest that esophageal surgery is typically more invasive, often involves longer hospital stays and more complications, and may therefore delay functional recovery, while the sex difference may partly reflect differences in household economic responsibility.

For the primary endpoint of working status at 18 months, the team used modified Poisson regression with robust standard errors to calculate risk ratios. Exploratory interaction analyses found no statistically significant difference between gastric and esophageal cancer in these associations, though the authors caution that the sample size limited that test.

In exploratory analyses adjusted for preoperative scores, sex, and age, three patient-reported measures at 6 months were significantly associated with not working at 18 months: pain, with a risk ratio of 2.08; appetite loss, with a risk ratio of 2.04; and financial impact, with a risk ratio of 2.09. Body weight loss of 10 percent or more at 6 months also carried a significantly elevated risk, with a risk ratio of 2.02 and a 95 percent confidence interval of 1.09 to 3.76. They stress, however, that whether targeted supportive care actually improves sustained work participation requires prospective validation.

More than half of participants worked in small enterprises with limited occupational health support and restricted access to sick leave. In that context, self-employment appeared protective, in contrast to a previous European systematic review, but the authors warn this may reflect greater autonomy in scheduling and flexible task allocation, or alternatively financial necessity, since self-employed patients who stop working lose income directly in the absence of employer-based sick-leave or wage-replacement benefits. They similarly caution that the sedentary-work association should not be read as evidence that such work itself facilitates participation, because unmeasured workplace factors such as remote or hybrid work opportunities and employer accommodations, along with residual confounding, may explain it. Sick pay systems also differ markedly across countries, from time-limited statutory sick pay in the United Kingdom to prolonged wage continuation in the Netherlands and no universal paid sick-leave mandate in the United States, which could influence work participation independent of health status.

The observational design precludes causal inference, and the authors acknowledge several further limitations. They could not fully distinguish cancer-related inability to work from planned or age-related retirement among older patients, so the association between age 65 or older and non-working status should not be interpreted as a direct indicator of cancer-related work disability. Pooled estimates combine gastric and esophageal cancer patients and should be read as average associations rather than cancer-specific ones. Post-return work intensity, reduced hours, workload, and presenteeism were not comprehensively captured, so binary working status may not fully reflect functional recovery or meaningful social reintegration. The modeling strategy also deliberately excluded potential mediators and socioeconomic variables closely tied to employment type to avoid overadjustment, which may have limited insight into the causal pathways. Still, the authors conclude that integrating standardized patient-reported outcome assessment and nutritional monitoring into routine postoperative follow-up may enable early identification of high-risk patients, and that survivorship care should incorporate vocational support and workplace coordination to prevent avoidable job loss, with the effectiveness of multidisciplinary interventions awaiting prospective validation.

Subject of Research: Return to work and working status after curative surgery for gastric and esophageal cancer

Article Title: Return‐To‐Work and Working Status After Surgery for Gastric and Esophageal Cancer: A Prospective Observational Study

Article References: Goto, K., Hisamori, S., Ueno, K., Abe, H., Okamura, R., Hosogi, H., Yamashita, Y., Manaka, D., Hata, H., Nishigori, T., Nakajima, S., Yamamoto, M., Kinoshita, K., Okumura, S., Sakaguchi, M., Tsunoda, S., Sakagami, Y., Hida, K., & Obama, K. (2026). Return‐To‐Work and Working Status After Surgery for Gastric and Esophageal Cancer: A Prospective Observational Study. Annals of Gastroenterological Surgery, 10(6), 1732-1742. https://doi.org/10.1002/ags3.70251

Image Credits: AI Generated

DOI: 10.1002/ags3.70251

Keywords: return to work, gastric cancer, esophageal cancer, cancer survivorship, surgery, working status, quality of life, financial toxicity, appetite loss, body weight loss, self-employment, Japan