Factors Affecting Cytokine Change After Esophagectomy for Esophageal Cancer

Okamura, Akihiko; Takeuchi, Hiroya; Matsuda, Satoru; Ogura, Masaharu; Miyasho, Taku; Nakamura, Rieko; Takahashi, Tsunehiro; Wada, Norihito; Kawakubo, Hirofumi; Saikawa, Yoshiro; Kitagawa, Yuukou

doi:10.1245/s10434-014-4348-4

Cited by 79 publications

(55 citation statements)

References 35 publications

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“…There are several possible reasons for the association between complications and poorer prognosis. Complications may lead to increased inflammation, affecting the immune system of patients after surgery and leading to increased production of proinflammatory cytokines such as interleukin (IL) 6 and IL‐8. This has been hypothesized to decrease the ability of the immune system to repress tumour recurrence.…”

Section: Discussionmentioning

confidence: 99%

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

et al. 2020

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Background: Recent evidence suggests that complications after oesophagectomy may decrease shortand long-term survival of patients with oesophageal cancer. This study aimed to analyse the impact of complications on survival in a Western cohort. Methods: Complications after oesophagectomy were recorded for all patients operated on between January 2006 and February 2017, with severity defined using the Clavien-Dindo classification. Associations between complications and overall and recurrence-free survival were assessed using univariable and multivariable Cox regression models. Results: Of 430 patients, 292 (67⋅9 per cent) developed postoperative complications, with 128 (39⋅8 per cent) classified as Clavien-Dindo grade III or IV. No significant associations were detected between Clavien-Dindo grade and either tumour (T) (P = 0⋅071) or nodal (N) status (P = 0⋅882). There was a significant correlation between Clavien-Dindo grade and ASA fitness grade (P = 0⋅032). In multivariable analysis, overall survival in patients with Clavien-Dindo grade I complications was similar to that in patients with no complications (hazard ratio (HR) 0⋅97, P = 0⋅915). However, patients with grade II and IV complications had significantly shorter overall survival than those with no complications: HR 1⋅64 (P = 0⋅007) and 1⋅74 (P = 0⋅013) respectively. Conclusion: Increasing severity of complications after oesophagectomy was associated with decreased overall survival. Prevention of complications should improve survival.Funding information Queen Elizabeth Hospital Birmingham Charity (Upper Gastrointestinal Fund) Upper G.I. Blues of the consensus reporting guidelines on oesophageal complications 11 , a lack of standardization of complication reporting made understanding the relationship between complications and long-term survival difficult.

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Section: Discussionmentioning

confidence: 99%

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

et al. 2020

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“…First, the immunosuppressive effects of a prolonged severe illness may allow micrometastatic disease to flourish into a clinically relevant recurrence more rapidly than it would otherwise. Infectious complications after oesophagogastric surgery have been reported to produce a proinflammatory cytokine (interleukins 6 and 8)‐mediated response, which may also promote tumour progression after oesophagectomy. Second, the prolonged period needed to recover from this severe illness frequently precludes adjuvant chemotherapy, which has been shown to confer a significant survival benefit in responders to neoadjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Saunders

Yanni

Dorrington

et al. 2019

British Journal of Surgery

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Background: Postoperative complications after resection of oesophagogastric carcinoma can result in considerable early morbidity and mortality. However, the long-term effects on survival are less clear. Methods: All patients undergoing intentionally curative resection for oesophageal or gastric cancer between 2006 and 2016 were selected from an institutional database. Patients were categorized by complication severity according to the Clavien-Dindo classification (grades 0-V). Complications were defined according to an international consensus statement. The effect of leak and severe non-leak-related complications on overall survival, recurrence and disease-free survival was assessed using Kaplan-Meier analyses to evaluate differences between groups. All factors significantly associated with survival in univariable analysis were entered into a Cox multivariable regression model with stepwise elimination. Results: Some 1100 patients were included, with a median age of 69 (range 28-92) years; 48⋅1 per cent had stage III disease and cancer recurred in 428 patients (38⋅9 per cent). Complications of grade III or higher occurred in 244 patients (22⋅2 per cent). The most common complications were pulmonary (29⋅9 per cent), with a 13⋅0 per cent incidence of pneumonia. Rates of atrial dysrhythmia and anastomotic leak were 10⋅0 and 9⋅6 per cent respectively. Patients with a grade III-IV leak did not have significantly reduced overall survival compared with those who had grade 0-I complications. However, patients with grade III-IV non-leak-related complications had reduced median overall survival (19⋅7 versus 42⋅7 months; P < 0⋅001) and disease-free survival (18⋅4 versus 36⋅4 months; P < 0⋅001). Cox regression analysis identified age, tumour stage, resection margin and grade III-IV non-leak-related complications as independent predictors of poor overall and disease-free survival. Conclusion: Beyond the acute postoperative period, anastomotic leak does not adversely affect survival, however, other severe postoperative complications do reduce long-term overall and disease-free survival. Statistical analysisContinuous variables are described as median (i.q.r. or range) or mean(s.d.), and were compared using the Mann-Whitney U test and Student's t test respectively. The χ 2 test was used for analysis of discrete data. OS was

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“…Patients may survive their complications but still not be fit enough anymore to complete adjuvant therapy or to be subjected to a proper follow‐up . In addition, postoperative complications were shown to have an immunomodulatory effect that has been suggested to impact on a wide range of postoperative outcomes .…”

Section: Discussionmentioning

confidence: 99%

Postoperative complications increase the risk of long‐term chronic kidney disease after nephron‐sparing surgery in patients with renal cancer and normal preoperative renal function

et al. 2019

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ObjectivesTo investigate whether postoperative complications affect long-term functional outcomes of renal patients treated with nephron-sparing surgery (NSS). Materials and MethodsWe performed an observational study, enrolling 596 patients with preoperative normal renal function treated with NSS for clinical T1abN0M0 renal masses. Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for chronic kidney disease (CKD) including as covariates age, comorbidity (scored according to the Charlson comorbidity index), hypertension, tumour size, preoperative estimated glomerular filtration rate (eGFR), eGFR < 60 mL/ min/1.73 m 2 at discharge, and ischaemia time. ResultsA total of 137 patients (23%) developed postoperative complications. At a median (interquartile range) follow-up of 53 (26-91) months, CKD risk was 19% for patients with postoperative complications and 11% for those without complications. Patients experiencing postoperative complications (HR 1.90, 95% CI 1.26-2.86) were at increased risk of developing CKD during the follow-up at multivariable analysis, after accounting for confounders. ConclusionsOur data outline how postoperative complications might have a detrimental impact on postoperative renal function in patients submitted to NSS. Improper patient selection, increasing the risk of postoperative complications, could limit the benefit in terms of renal function brought by NSS.

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Factors Affecting Cytokine Change After Esophagectomy for Esophageal Cancer

Cited by 79 publications

References 35 publications

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Impact of postoperative complications on disease recurrence and long-term survival following oesophagogastric cancer resection

Postoperative complications increase the risk of long‐term chronic kidney disease after nephron‐sparing surgery in patients with renal cancer and normal preoperative renal function

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