Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Bundred, James; Hollis, Alexander Conor; Evans, Richard; Hodson, James; Whiting, John; Griffiths, Ewen

doi:10.1002/bjs5.50264

Cited by 24 publications

(24 citation statements)

References 51 publications

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“…Although short-term morbidity was increased after transhiatal minimally invasive esoph-agectomy, postoperative morbidity was comparable after transtho-racic minimally invasive and open esophagectomies in the present study. As a complicated postoperative course was associated with worse long-term outcomes, 10,15,20 prevention of short-term morbidity after minimally invasive esophagectomy should have an important focus.…”

Section: Discussionmentioning

confidence: 99%

Long-term Survival After Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer

Kalff¹,

Fransen²,

Groot³

et al. 2020

Annals of Surgery

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Objectives: This study aimed to compare long-term survival following MIE versus OE for esophageal cancer using a nationwide propensityscore matched cohort. Summary of Background Data: MIE provides lower postoperative morbidity and mortality, and similar short-term oncological quality compared to OE. Methods: Data was acquired from the Dutch Upper Gastrointestinal Cancer Audit. Patients undergoing minimally invasive or open, transthoracic or transhiatal esophagectomy for primary esophageal cancer between 2011 and 2015 were included. A propensity-score matching analysis for MIE versus OE was performed separately for transthoracic and transhiatal esoph-agectomies. Results: A total of 1036 transthoracic MIE and OE patients, and 582 transhiatal MIE and OE patients were matched. Long-term survival was comparable for MIE and OE for both transthoracic and transhiatal procedures (5-year overall survival: transthoracic MIE 49.2% vs OE 51.1%, P 0.695; transhiatal MIE 48.4% vs OE 50.7%, P 0.832). For both procedures, MIE yielded more lymph nodes (transthoracic median 21 vs 18, P < 0.001; transhiatal 15 vs 13, P 0.007). Postoperative morbidity was comparable after transthoracic MIE and OE (60.8% vs 64.9%, P 0.177), with a reduced length of stay after transthoracic MIE (median 12 vs 15 days, P < 0.001). After transhiatal MIE, more postoperative complications (64.9% vs 56.4%, P 0.034) were observed, without subsequent difference in length of stay. Conclusion: Long-term survival after MIE was equivalent to open in both propensity-score matched cohorts of patients undergoing transthoracic or transhiatal esophageal resections. Transhiatal MIE was accompanied with more postoperative morbidity. Both transthoracic and transhiatal MIE resulted in a more extended lymphadenectomy.

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Section: Discussionmentioning

confidence: 99%

Long-term Survival After Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer

Kalff¹,

Fransen²,

Groot³

et al. 2020

Annals of Surgery

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“…Previously, it has been shown that early detection of PIC is essential not only for the treatment of complications but also for patient survival [ 20 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ]. PICs, according to the definition used for this paper, include surgical site infections, pneumonia, pleural empyema, leakage or necrosis of the gastric conduit, and anastomotic leakage [ 33 , 39 ]. Indisputably, these complications are of different importance and severity.…”

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein as Predictor for Infectious Complications after Robotic and Open Esophagectomies

Richter

Mehdorn

Fedders

et al. 2022

JCM

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Introduction: The value of C-reactive protein (CRP) as a predictor of anastomotic leakage (AL) after esophagectomy has been addressed by numerous studies. Despite its increasing application, robotic esophagectomy (RAMIE) has not been considered separately yet in this context. We, therefore, aimed to evaluate the predictive value of CRP in RAMIE. Material and Methods: Patients undergoing RAMIE or completely open esophagectomy (OE) at our University Center were included. Clinical data, CRP- and Procalcitonin (PCT)-values were retrieved from a prospectively maintained database and evaluated for their predictive value for subsequent postoperative infectious complications (PIC) (AL, gastric conduit leakage or necrosis, pneumonia, empyema). Results: Three hundred and five patients (RAMIE: 160, OE: 145) were analyzed. PIC were noted in 91 patients on postoperative day (POD) 10 and 123 patients on POD 30, respectively. Median POD of diagnosis of PIC was POD 8. Post-operative CRP-values in the robotic-group peaked one and two days later, respectively, and converged from POD 5 onward compared to the open-group. In the group with PIC, CRP-levels in the robotic-group were initially lower and started to differ significantly from POD 3 onward. In the open-group, increases were already noticed from POD 3 on. Procalcitonin levels did not differ. Best Receiver operating curve (ROC)-results were on POD 4, highest negative predictive values at POD 5 (RAMIE) and POD 4 (OE) with cut-off values of 70 mg/L and 88.3 mg/L, respectively. Conclusion: Post-operative CRP is a good negative predictor for PIC, after both RAMIE and OE. After RAMIE, CRP peaks later with a lower cut-off value.

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“…Postoperative complications are independently associated with decreased survival due to cancer recurrence [ 30 ], and prevention of complications may improve survival [ 31 ]. Wang W et al reported that thoracic epidural anesthesia did not affect the risk of AL occurrence after esophageal surgery for cancer [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Is there a relationship between two different anesthetic methods and postoperative length of stay during radical resection of malignant esophageal tumors in China?: a retrospective cohort study

Yang

Guo

Zheng³

et al. 2022

BMC Anesthesiol

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Background Data providing a relationship between the anesthetic method and postoperative length of stay (PLOS) is limited. We aimed to investigate whether general anesthesia alone or combined with epidural anesthesia might affect perioperative risk factors and PLOS for patients undergoing radical resection of malignant esophageal tumors. Methods The study retrospectively analyzed the clinical data of 680 patients who underwent a radical esophageal malignant tumor resection in a Chinese hospital from January 01, 2010, to December 31, 2020. The primary outcome measure was PLOS, and the secondary outcome was perioperative risk-related parameters that affect PLOS. The independent variable was the type of anesthesia: general anesthesia (GA) or combined epidural-general anesthesia (E-GA). The dependent variable was PLOS. We conducted univariate and multivariate logistic regression and propensity score matching to compare the relationships of GA and E-GA with PLOS and identify the perioperative risk factors for PLOS. In this cohort study, the confounders included sociodemographic data, preoperative chemotherapy, coexisting diseases, laboratory parameters, intraoperative variables, and postoperative complications. Results In all patients, the average PLOS was 19.85 ± 12.60 days. There was no significant difference in PLOS between the GA group and the E-GA group either before or after propensity score matching (20.01 days ± 14.90 days vs. 19.79 days ± 11.57 days, P = 0.094, 18.09 ± 9.71 days vs. 19.39 ± 10.75 days, P = 0.145). The significant risk factors for increased PLOS were lung infection (β = 3.35, 95% confidence interval (CI): 1.54–5.52), anastomotic leakage (β = 25.73, 95% CI: 22.11–29.34), and surgical site infection (β = 9.39, 95% CI: 4.10-14.68) by multivariate regression analysis. Subgroup analysis revealed a stronger association between PLOS and vasoactive drug use, blood transfusions, and open esophagectomy. The results remained essentially the same (stable and reliable) after subgroup analysis. Conclusions Although there is no significant association between the type of anesthesia(GA or E-GA) and PLOS for patients undergoing radical esophageal malignant tumor resection, an association between PLOS and lung infection, anastomotic leakage, and surgical site infection was determined by multivariate regression analysis. A larger sample future study design may verify our results.

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Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

Cited by 24 publications

References 51 publications

Long-term Survival After Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer

Long-term Survival After Minimally Invasive Versus Open Esophagectomy for Esophageal Cancer

C-Reactive Protein as Predictor for Infectious Complications after Robotic and Open Esophagectomies

Is there a relationship between two different anesthetic methods and postoperative length of stay during radical resection of malignant esophageal tumors in China?: a retrospective cohort study

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