New-onset Atrial Fibrillation Post-surgery for Esophageal and Junctional Cancer

Abstract

A total of 473 patients (mean age: 63 years; 73% male) underwent resection, 51% 2-stage, 18% 3-stage, 12% transhiatal, and 19% extended total gastrectomy. Ninety-six (20%) patients developed new-onset AF, in 18%, 27%, 29%, and 14% of 2-, 3-, transhiatal, and extended total gastrectomy cohorts, respectively (P=0.05). Age, diabetes, neoadjuvant therapy, and cardiac history predisposed (P<0.05) to AF, and AF was significantly (P<0.0001) associated with pneumonia, pleural effusions requiring drainage, and maximum postoperative C-reactive protein (CRP) (P<0.05) but not with anastomotic leak/conduit necrosis or mortality. Amiodarone was the primary treatment in 63% of cases, 1% underwent cardioversion, and 92% were in sinus rhythm on discharge. At a median follow-up of 40 months (7-109 months), the median survival was 40 months versus 53 months in the AF and non-AF cohorts, respectively (P=0.353) CONCLUSIONS: New-onset AF is common, linked to age, diabetes, cardiac disease, and neoadjuvant therapy. It is strongly associated with complications, principally respiratory sepsis, and systemic inflammation. For most, it resolves, with no impact on oncologic outcomes.

Laparoscopic Gastric Mobilization Reduces Postoperative Mortality After Esophageal Cancer Surgery

“…13,23 Moreover, we confirmed the negative impact of malnutrition on POM. 24 Therefore, these results advocate for the importance of conditioning and rehabilitation before esophagectomy, with screening and correction of malnutrition, smoking cessation, and preoptimization of pulmonary and cardiac conditions.…”

Does the modified Glasgow Prognostic Score (mGPS) have a prognostic role in esophageal cancer?

“…The incidence of adenocarcinoma of the esophagus and gastroesophageal junction has risen significantly in recent years, particularly in the West [1]. It carries a poor prognosis, with an overall 5-year survival of approximately 15%, and approximately 40% in patients who can be treated with curative intent [2,3]. Moreover, operative morbidity is high, and the risk of in-hospital mortality even in the best-reported series is up to 5%.…”

Randomized clinical trial of landiolol hydrochloride for the prevention of atrial fibrillation and postoperative complications after oesophagectomy for cancer

“…Between March 2013 and January 2016, 128 patients were scheduled to undergo oesophagectomy for thoracic oesophageal cancer. Of these, 28 were excluded from the study on POD 1 before randomization because of failure to meet the inclusion criteria (24), complication with an intraoperative aortic injury (1), need for reoperation for diaphragmatic hernia (1) and refusal to participate (2). The remaining 100 patients were randomized; 50 patients were treated with 5 per cent glucose solution (placebo group) and 50 received landiolol (landiolol group) ( Fig.…”

“…Oesophagectomy for cancer is high-risk surgery with considerable morbidity and mortality 1,2 . New-onset atrial fibrillation (AF) after oesophagectomy has been reported, with a variable incidence of 9-46 per cent 2 -8 .…”

“…New-onset atrial fibrillation (AF) after oesophagectomy has been reported, with a variable incidence of 9-46 per cent 2 -8 . This new-onset AF may be associated with complications 2,3,8 , directly by increasing the risks of embolic events and ischaemic events, and indirectly by increasing complications through haemodynamic instability and organ hypoperfusion. In this way, AF may be associated with respiratory complications, anastomotic leak and severe infection 2 .…”