Influence of Postoperative Pneumonia on Esophageal Cancer Survival and Recurrence

Tamagawa, Ayako; Aoyama, Toru; Ju, Mihwa; Komori, Keisuke; Maezawa, Yukio; Kano, Kazuki; Kazama, Keisuke; Murakawa, Masaaki; Atsumi, Yoshihito; Sawazaki, Sho; Hara, Kentaro; Numata, Masakatsu; Sato, Tsutomu; Yukawa, Norio; Masuda, Munetaka; Rino, Yasushi

doi:10.21873/anticanres.13392

Cited by 26 publications

(25 citation statements)

References 15 publications

(17 reference statements)

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“…13 Several studies identify postoperative pneumonia as a predictor of short-term and long-term mortality after surgery. [14][15][16][17][18][19] Is there a difference in the outcomes of postoperative pneumonia between patients with and without T2DM?…”

Section: Introductionmentioning

confidence: 99%

<p>The Effects of Type 2 Diabetes and Postoperative Pneumonia on the Mortality in Inpatients with Surgery</p>

Liu

et al. 2019

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The aim of the study was to explore the relationship between type 2 diabetes (T2DM) and postoperative pneumonia, and the effects of T2DM and postoperative pneumonia on the mortality in inpatients with surgery. Methods: A retrospective study was conducted on 43,174 inpatients with surgery in The First Hospital of Qinhuangdao. These patients were divided into four groups according to T2DM and postoperative pneumonia, Group A subjects without T2DM and postoperative pneumonia, Group B subjects with T2DM only, Group C subjects with postoperative pneumonia only and Group D subjects with T2DM and postoperative pneumonia. Inhospital mortality was collected. Results: The incidences of postoperative pneumonia were higher in patients with T2DM than patients without T2DM (T2DM 3.2% vs Non-diabetes 1.7%, χ 2 =36.219, P<0.001). The mortalities were 0.3% in Group A, 0.3% in Group B, 4.6% in Group C and 8.6% in Group D. In multiple logistic regression analysis, adjusted for sex, age, emergency admissions, coronary heart disease, heart failure, chronic kidney disease, hypoproteinemia, stroke and transient ischemic attack, the mortalities of Group C and Group D were 4.515 (95% CI: 2.779～7.336, P<0.001) times and 8.468 (95% CI: 3.567～20.099, P<0.001) times than the mortality of Group A. Conclusion: T2DM is susceptible to postoperative pneumonia. The mortality increased in patients with postoperative pneumonia. When patients with T2DM and postoperative pneumonia at the same time, the mortality increased further. In T2DM patients with postoperative pneumonia, perioperative management should be improved for patient safety.

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Section: Introductionmentioning

confidence: 99%

<p>The Effects of Type 2 Diabetes and Postoperative Pneumonia on the Mortality in Inpatients with Surgery</p>

Liu

et al. 2019

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“…Elderly esophageal cancer patients generally have co-morbidities and age-related physiological problems (6)(7)(8). Previous reports have shown that the postoperative surgical complication rates after esophagectomy are 30% to 70%, and the mortality rate is 1%-5% (9)(10)(11)(12). Given this situation, perioperative management might be difficult in elderly esophageal cancer patients.…”

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confidence: 99%

The Clinical Impact of the Age-adjusted Charlson Comorbidity Index on Esophageal Cancer Patients Who Receive Curative Treatment

Aoyama

Atsumi

Kawahara

et al. 2020

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Background/Aim: We investigated the impact of the age-adjusted Charlson comorbidity index (ACCI) on esophageal cancer survival and recurrence after curative treatment. Patients and Methods: This study included 122 patients who underwent curative surgery followed by adjuvant chemotherapy for esophageal cancer between 2005 and 2017. The risk factors for the overall survival (OS) and recurrencefree survival (RFS) were identified. Results: An ACCI of 5 was regarded as the optimal critical point of classification considering the survival rates. The OS rates at 3 and 5 years after surgery were 64.2% and 54.4% in the low-ACCI group, respectively, and 42.3% and 29.2% in high-ACCI group, respectively (p=0.035). The RFS rates at 3 and 5 years after surgery were 50.2% and 43.6% in the low-ACCI group, respectively, and 28.5% and 21.3% in high-ACCI group, respectively (p=0.021). A multivariate analysis demonstrated that ACCI was a significant independent risk factor for both the OS and RFS. Conclusion: ACCI is a risk factor for survival in patients who undergo curative treatment for esophageal cancer. An effective plan for the perioperative care and surgical strategy should be developed according to ACCI. Esophageal cancer is the seventh-most common cancer and the sixth leading cause of cancer-related mortality. An 2783 This article is freely accessible online.

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“…Hospitals must balance the consumption of resources potentially needed for COVID patients with the potential harm to cancer patients if operations are delayed. As survival from esophageal cancer precipitously decreases with stage progression [ 15 , 36 , 37 ], we created a simple and informative model to estimate the potential harm to a patient with an early stage cT1b esophageal adenocarcinoma if his care was delayed due to the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…As COVID-19 is a new disease emerging in late 2019 there is no long-term follow up of patients available for reference. To approximate the effect of COVID-19 on overall survival after esophagectomy, we utilized available data on the impact of significant pulmonary complications after esophagectomy on 5-year overall survival [ 15 , 36 ]. The decrease in 5-year overall survival due to COVID-19 was set at 0.26 (range 0.1–0.35), and this was used to discount the cancer-related survival for each stage.…”

Section: Methodsmentioning

confidence: 99%

Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19

et al. 2020

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Background Surgical society guidelines have recommended changing the treatment strategy for early esophageal cancer during the novel coronavirus (COVID-19) pandemic. Delaying resection can allow for interim disease progression, but the impact of this delay on mortality is unknown. The COVID-19 infection rate at which immediate operative risk exceeds benefit is unknown. We sought to model immediate versus delayed surgical resection in a T1b esophageal adenocarcinoma. Methods A decision analysis model was developed, and sensitivity analyses performed. The base case was a 65-year-old male smoker presenting with cT1b esophageal adenocarcinoma scheduled for esophagectomy during the COVID-19 pandemic. We compared immediate surgical resection to delayed resection after 3 months. The likelihood of key outcomes was derived from the literature where available. The outcome was 5-year overall survival. Results Proceeding with immediate esophagectomy for the base case scenario resulted in slightly improved 5-year overall survival when compared to delaying surgery by 3 months (5-year overall survival 0.74 for immediate and 0.73 for delayed resection). In sensitivity analyses, a delayed approach became preferred when the probability of perioperative COVID-19 infection increased above 7%. Conclusions Immediate resection of early esophageal cancer during the COVID-19 pandemic did not decrease 5-year survival when compared to resection after 3 months for the base case scenario. However, as the risk of perioperative COVID-19 infection increases above 7%, a delayed approach has improved 5-year survival. This balance should be frequently re-examined by surgeons as infection risk changes in each hospital and community throughout the COVID-19 pandemic.

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Influence of Postoperative Pneumonia on Esophageal Cancer Survival and Recurrence

Cited by 26 publications

References 15 publications

<p>The Effects of Type 2 Diabetes and Postoperative Pneumonia on the Mortality in Inpatients with Surgery</p>

<p>The Effects of Type 2 Diabetes and Postoperative Pneumonia on the Mortality in Inpatients with Surgery</p>

The Clinical Impact of the Age-adjusted Charlson Comorbidity Index on Esophageal Cancer Patients Who Receive Curative Treatment

Modeling the impact of delaying surgery for early esophageal cancer in the era of COVID-19

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