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

Saunders, J.; Yanni, Fady; Dorrington, M S; Bowman, C R; Vohra, Ravinder; Parsons, Simon L.

doi:10.1002/bjs.11318

Cited by 40 publications

(31 citation statements)

References 35 publications

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“…In this study, the incidence of POI was 20.6%, which is comparable to previous findings [ 17 , 18 ]. The multivariable regression analysis of this retrospective study showed that length of stay, albumin, intraoperative bleeding, and perioperative blood transfusion were independent factors of POI.…”

Section: Discussionsupporting

confidence: 91%

A nomogram for predicting postoperative pulmonary infection in esophageal cancer patients

Sui

et al. 2021

BMC Pulm Med

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Background Although postoperative pulmonary infection (POI) commonly occurs in patients with esophageal cancer after curative surgery, a patient-specific predictive model is still lacking. The main aim of this study is to construct and validate a nomogram for estimating the risk of POI by investigating how perioperative features contribute to POI. Methods This cohort study enrolled 637 patients with esophageal cancer. Perioperative information on participants was collected to develop and validate a nomogram for predicting postoperative pulmonary infection in esophageal cancer. Predictive accuracy, discriminatory capability, and clinical usefulness were evaluated by calibration curves, concordance index (C-index), and decision curve analysis (DCA). Results Multivariable logistic regression analysis indicated that length of stay, albumin, intraoperative bleeding, and perioperative blood transfusion were independent predictors of POI. The nomogram for assessing individual risk of POI indicated good predictive accuracy in the primary cohort (C-index, 0.802) and validation cohort (C-index, 0.763). Good consistency between predicted risk and observed actual risk was presented as the calibration curve. The nomogram for estimating POI of esophageal cancer had superior net benefit with a wide range of threshold probabilities (4–81%). Conclusions The present study provided a nomogram developed with perioperative features to assess the individual probability of infection may conducive to strengthen awareness of infection control and provide appropriate resources to manage patients at high risk following esophagectomy.

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Section: Discussionsupporting

confidence: 91%

A nomogram for predicting postoperative pulmonary infection in esophageal cancer patients

Sui

et al. 2021

BMC Pulm Med

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“…Leakage associated with grade III–V complications, according to the Clavien–Dindo grading system 16,17 , was defined as severe AL, and that associated with less severe complications (grade I–II) as non‐severe AL. All patients who died within 30 days of surgery were excluded from the adjusted analyses of long‐term survival, consistent with previous studies 9,18 .…”

Section: Methodsmentioning

confidence: 89%

Impact of anastomotic leak on long-term survival in patients undergoing gastrectomy for gastric cancer

Kamarajah

Navidi

Griffin

et al. 2020

British Journal of Surgery

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Background: The impact of anastomotic leak (AL) on long-term outcomes after gastrectomy for gastric adenocarcinoma is poorly understood. This study determined whether AL contributes to poor overall survival. Methods: Consecutive patients undergoing gastrectomy in a single high-volume unit between 1997 and 2016 were evaluated. Clinicopathological characteristics, oncological and postoperative outcomes were stratified according to whether patients had no AL, non-severe AL or severe AL. Severe AL was defined as anastomotic leakage associated with Clavien-Dindo Grade III-IV complications. Results: The study included 969 patients, of whom 58 (6⋅0 per cent) developed AL; 15 of the 58 patients developed severe leakage. Severe AL was associated with prolonged hospital stay (median 50, 30 and 13 days for patients with severe AL, non-severe AL and no AL respectively; P < 0⋅001) and critical care stay (median 11, 0 and 0 days; P < 0⋅001). There were no significant differences between groups in number of lymph nodes harvested (median 29, 30 and 28; P = 0⋅528) and R1 resection rates (7, 5 and 6⋅5 per cent; P = 0⋅891). Cox multivariable regression analysis showed that severe AL was independently associated with overall survival (hazard ratio 3⋅96, 95 per cent c.i. 2⋅11 to 7⋅44; P < 0⋅001) but not recurrence-free survival. In sensitivity analysis, the results for patients who had neoadjuvant therapy then gastrectomy were similar to those for the entire cohort. Conclusion: AL prolongs hospital stay and is associated with compromised long-term overall survival.

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“…Previous reports on the mechanism of postoperative complications negatively affecting the prognosis of patients with malignant tumors have been inconsistent. JH Saunders et al found that postoperative anastomotic leakage did not affect the long-term survival of patients with esophageal cancer, but other serious complications (except for anastomotic leakage) were identi ed as independent prognostic factors for overall survival and diseasefree survival [25]. In the eld of GC, Masanori et al found in the JCOG1001 study that, regardless of the type or degree of complications after radical GC, postoperative complications were associated with poor OS [26].…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, an increasing number of scholars have reported that postoperative complications (PCs) after surgical operations are closely related to the poor prognosis of patients with malignant tumors [23][24][25][26][27]. This retrospective study analyzed this adverse effect and explored whether adjuvant chemotherapy (AC) and the time interval (TI) from radical operation to initiation of adjuvant chemotherapy could abolish the poor prognosis caused by PCs in patients with stage II/III GC.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Adjuvant Chemotherapy Cancel Out the Negative Survival Impact on Stage II/III Gastric Cancer Patients With Postoperative Complications

Song

Lü

Lin

et al. 2022

Preprint

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Purpose The potential additive influence of adjuvant chemotherapy (AC) on prognosis of patients with stage II/III gastric cancer (GC) who experienced complications after radical surgery is unclear.Methods The whole group was divided into a postoperative complication (PC) group and a postoperative non-complication (NPC) group, and the overall survival (OS) rate, recurrence-free survival (RFS) rate and recurrence rate were compared between the two groups of patients. Results A total of 1563 patients between January 2010 and December 2015 in our center were included in this analysis. There were 268 patients (17.14%) in the PC group and 1295 patients (82.86%) in the NPC group. The 5-year OS rate of the PC group was 55.2%, the NPC group was 63.3%; and the 5-year RFS rate of the PC group was 53.7%, the non-PC group was 58.8%. Recurrence patterns showed no significant difference between the two group (all p>0.05). Adjuvant chemotherapy (AC) significantly improved the OS and RFS rates of patients with and without PCs (both p<0.05), and it showed no significant difference between the PC group and the NPC group who received AC (both p> 0.05). Stratified analysis showed that AC only improve the OS or RFS rates of stage III patients (both p<0.05). Further stratified analysis of the time interval (TI) from operation to initiation of AC in the PC group showed that a TI after 6 weeks (≥6eeks) improved only the OS and RFS rates of stage III patients, while when a TI within 6 weeks (＜6weeks), a benefit was observed in stage II and III patients (both p<0.05).Conclusion AC can abolish the negative effect of PCs on the long-term survival of patients with stage III GC; for stage II patients, the above offset effect is affected by the TI. Delaying AC initiation after 6 weeks may not improve the survival of patients experienced stage II GC with complications.

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

Cited by 40 publications

References 35 publications

A nomogram for predicting postoperative pulmonary infection in esophageal cancer patients

A nomogram for predicting postoperative pulmonary infection in esophageal cancer patients

Impact of anastomotic leak on long-term survival in patients undergoing gastrectomy for gastric cancer

Postoperative Adjuvant Chemotherapy Cancel Out the Negative Survival Impact on Stage II/III Gastric Cancer Patients With Postoperative Complications

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