Epidemiology of Postoperative Complications After Esophagectomy: Implications for Management

Kalata, Stanley; Singh, Bilawal; Graham, Nathan; Fan, Zhaohui; Chang, Andrew C.; Lynch, William R.; Lagisetty, Kiran H.; Lin, Jules; Yeung, Jonathan; Reddy, Rishindra M.; Wakeam, Elliot

doi:10.1016/j.athoracsur.2023.09.004

Cited by 6 publications

(2 citation statements)

References 32 publications

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“…Complications following esophageal cancer surgery remain a major concern, with over 50% of patients experiencing them [37]. The most commonly reported complications include leakages at the anastomosis, heart rhythm anomalies, pneumonia/aspiration, chylothorax, and recurrent nerve damage [15,38]. Various factors contribute to these complications, including age, health conditions, nutritional status, prior chemoradiation therapy, surgical technique, and extent of lymph node dissection [39].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Impact of Severe Postoperative Complications after Esophagectomy for Cancer: Individual Patient Data Meta-Analysis

Bona,

Manara,

Bonitta

et al. 2024

Cancers

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Background. Severe postoperative complications (SPCs) may occur after curative esophagectomy for cancer and are associated with prolonged hospital stay, augmented costs, and increased in-hospital mortality. However, the effect of SPCs on survival after esophagectomy is uncertain. Aim. To assess the impact of severe postoperative complications (SPCs) on long-term survival following curative esophagectomy for cancer, we conducted a systematic search of PubMed, MEDLINE, Scopus, and Web of Science databases up to December 2023. The included studies examined the relationship between SPCs and survival outcomes, defining SPCs as Clavien–Dindo grade > 3. The primary outcome measure was long-term overall survival (OS). We used restricted mean survival time difference (RMSTD) and 95% confidence intervals (CIs) to calculate pooled effect sizes. Additionally, we applied the GRADE methodology to evaluate the certainty of the evidence. Results. Ten studies (2181 patients) were included. SPCs were reported in 651 (29.8%) patients. The RMSTD overall survival analysis shows that at 60-month follow-up, patients experiencing SPCs lived for 8.6 months (95% Cis −12.5, −4.7; p < 0.001) less, on average, compared with no-SPC patients. No differences were found for 60-month follow-up disease-free survival (−4.6 months, 95% CIs −11.9, 1.9; p = 0.17) and cancer-specific survival (−6.8 months, 95% CIs −11.9, 1.7; p = 0.21). The GRADE certainty of this evidence ranged from low to very low. Conclusions. This study suggests a statistically significant detrimental effect of SPCs on OS in patients undergoing curative esophagectomy for cancer. Also, a clinical trend toward reduced CSS and DFS was perceived.

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Section: Discussionmentioning

confidence: 99%

Long-Term Impact of Severe Postoperative Complications after Esophagectomy for Cancer: Individual Patient Data Meta-Analysis

Bona,

Manara,

Bonitta

et al. 2024

Cancers

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“…This could be attributed to the diverse management of high-risk patients after surgery having a comprehensive impact on improving the occurrence of anastomotic leakage and pneumonia. Previous studies have suggested that pneumonia and anastomotic leakage are closely linked ( 27 ). Anastomotic leakage can contribute to the spread of local inflammation, leading to pleural or mediastinal effusion and promoting pneumonia occurrence.…”

Section: Discussionmentioning

confidence: 99%

An esophagectomy surgical Apgar score-based nomogram—a risk-based postoperative triage system: a phase II randomised trial

Chen,

Xi,

Lin

et al. 2024

J Thorac Dis

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Background The esophagectomy surgical Apgar score (eSAS) has been found to be a predictor of postoperative complications in esophagectomy. In our previous study, we built a graphic nomogram based on eSAS and demonstrated that it can effectively predict the risk of major morbidity after esophagectomy. In this study, we aimed to assess the benefits of using an eSAS-based nomogram model as a postoperative risk-based triage system for patients undergoing esophagectomy. Methods We enrolled 119 patients diagnosed with esophageal carcinoma and randomly assigned them to a nomogram group (NG) or control group (CG) from January 2019 to December 2020. Patients in the NG were assigned to a low-risk group and high-risk group based on the nomogram. Patients in the high-risk group were admitted to the intensive care unit (ICU) after esophagectomy. Risk estimation in the CG patients was based on the surgeon’s clinical experience. Thirty-day major complications, postoperative hospital stay, hospital costs, and quality of life (QOL) during the follow-up were compared between the two groups. Results Baseline clinicopathological characteristics were comparable between the NG (n=58) and CG (n=61). All patients underwent esophagectomy. Postoperative complications were significantly higher in the CG (30, 49.2%) than in the NG (14, 24.1%) (P=0.008), with pneumonia being the most common (CG: 23, 37.7%; NG: 12, 20.7%; P=0.042). There was no significant difference in anastomotic leakage (NG: 1, 1.7%; CG: 6, 9.8%; P=0.12). Postoperative median hospital stay was shorter in the NG (14 days) than in the CG (16 days) (P=0.041). Hospital costs (NG: ¥60,045.1; CG: ¥63,961.5; P=0.21) and postoperative QOL did not differ significantly between groups. Conclusions An eSAS-based nomogram as a triage system can reduce the overall occurrence of postoperative complications and shorten postoperative hospital stay without increasing hospital costs. Trial Registration Chinese Clinical Trial Registry ChiCTR1900021636.

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Anastomotic Leak After Esophagectomy—Searching for a Crystal Ball

Servais

2023

The Annals of Thoracic Surgery

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Epidemiology of Postoperative Complications After Esophagectomy: Implications for Management

Cited by 6 publications

References 32 publications

Long-Term Impact of Severe Postoperative Complications after Esophagectomy for Cancer: Individual Patient Data Meta-Analysis

Long-Term Impact of Severe Postoperative Complications after Esophagectomy for Cancer: Individual Patient Data Meta-Analysis

An esophagectomy surgical Apgar score-based nomogram—a risk-based postoperative triage system: a phase II randomised trial

Anastomotic Leak After Esophagectomy—Searching for a Crystal Ball

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