Outcome, complications, and mortality of an intrathoracic anastomosis in esophageal cancer in patients without a preoperative selection with a risk score

Alldinger, Ingo; Sisic, Leila; Hochreiter, Marcel; Weichert, Wilko; Blank, Susanne; Burian, Maria; Grenacher, Lars; Bruckner, Tom; Werner, Jens; Büchler, Markus W.; Ott, Katja

doi:10.1007/s00423-014-1257-8

Cited by 22 publications

(27 citation statements)

References 41 publications

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“…Most survival rates reported in the literature are static, being calculated from the day of diagnosis or surgery. However, the risk of death changes with time after surgery.…”

Section: Introductionmentioning

confidence: 99%

Conditional survival after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer

Hagens

Feenstra

Eshuis

et al. 2020

British Journal of Surgery

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Background Conditional survival accounts for the time already survived after surgery and may be of additional informative value. The aim was to assess conditional survival in patients with oesophageal cancer and to create a nomogram predicting the conditional probability of survival after oesophagectomy. Methods This retrospective study included consecutive patients with oesophageal cancer who received neoadjuvant chemoradiation followed by oesophagectomy between January 2004 and 2019. Conditional survival was defined as the probability of surviving y years after already surviving for x years. The formula used for conditional survival (CS) was: CS(x|y) = S(x + y)/S(x), where S(x) represents overall survival at x years. Cox proportional hazards models were used to evaluate predictors of overall survival. A nomogram was constructed to predict 5‐year survival directly after surgery and given survival for 1, 2, 3 and 4 years after surgery. Results Some 660 patients were included. Median overall survival was 44·4 (95 per cent c.i. 37·0 to 51·8) months. The probability of achieving 5‐year overall survival after resection increased from 45 per cent directly after surgery to 54, 65, 79 and 88 per cent given 1, 2, 3 and 4 years already survived respectively. Cardiac co‐morbidity, cN category, ypT category, ypN category, chyle leakage and pulmonary complications were independent predictors of survival. The nomogram predicted 5‐year survival using these predictors and number of years already survived. Conclusion The probability of achieving 5‐year overall survival after oesophagectomy for cancer increases with each additional year survived. The proposed nomogram predicts survival in patients after oesophagectomy, taking the years already survived into account.

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“…Most survival rates reported in the literature are static, being calculated from the day of diagnosis or surgery. However, the risk of death changes with time after surgery.…”

Section: Introductionmentioning

confidence: 99%

Conditional survival after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer

Hagens

Feenstra

Eshuis

et al. 2020

British Journal of Surgery

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“…[32][33][34] The median survival was significantly reduced in patients treated with stents (SG) compared with the group of patients treated without stents (NSG). The recurrence-free period was likewise reduced, but even though there was a significant difference in the KaplanMeier plots for the SG compared to NSG, the adjusted hazard ratio of 1.46 was not statistical significant different (P 5 0.076).…”

Section: Discussionmentioning

confidence: 98%

A bridging stent to surgery in patients with esophageal and gastroesophageal junction cancer has a dramatic negative impact on patient survival

Kjær

Nassar

Jensen

et al. 2016

Diseases of the Esophagus

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This study aimed to assess the impact of esophageal stenting on postoperative complications and survival in patients with obstructing esophageal and gastroesophageal junction (GEJ) cancer. All patients treated without neoadjuvant therapy that had an R0-resection performed for esophageal and GEJ cancer between January 2003 and December 2010 were identified from a prospectively maintained database. Data on stenting, postoperative mortality, morbidity, recurrence-free survival, complications, and length of hospital stay were collected. Kaplan-Meier plots for survival and recurrence-free survival curves were constructed for R0 resected patients. Data were compared between the stent and no-stent group by nonparametric tests. Two hundred seventy three consecutive R0 resected patients with esophageal or GEJ cancer were identified. Of these patients, 63 had a stent as a bridge to surgery. The male/female ratio was 2.64 (198/75) with a median age in the stent group (SG) of 65.1 versus 64.3 in the no stent group (NSG). Patients were comparable with respect to gender, age, smoking, TNM-classification, oncological treatment, hospital stay, tumor location, and histology. The median survival in the SG was 11.6 months compared with 21.3 months for patients treated without a bridging stent (P < 0.001). There were no statistically significant differences in 30-day mortality between the two groups, but NSG patients exhibited a significantly better two-year survival (P = 0.017). The median recurrence-free survival was 9.1 months for the SG compared with 15.2 months for the NSG. The use of a stent as a bridging procedure to surgery in patients treated without neaoadjuvant therapy for an esophageal or GEJ cancer that later underwent R0 resection decreased the two year survival and the recurrence-free survival.

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“…An alternative approach is an abdominal (transhiatal) esophagectomy, without mediastinal lymphadenectomy, with fewer pulmonary complications and lower mortality . Identifying preoperative risk factors for the development of postoperative complications is important for outcome improvement and for development of new preventive strategies that might guide patient selection . The most frequent complications following esophagectomy are anastomotic leakage and pulmonary complications.…”

Section: Preoperative Risk Factors For Mortality and Complications Fomentioning

confidence: 99%

Current treatment options for esophageal diseases

Martínek

Akiyama

Vacková

et al. 2016

Annals of the New York Academy of Sciences

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Exciting new developments-pharmacologic, endoscopic, and surgical-have arisen for the treatment of many esophageal diseases. Refractory gastroesophageal reflux disease presents a therapeutic challenge, and several new options have been proposed to overcome an insufficient effectiveness of proton pump inhibitors. In patients with distal esophageal spasm, drugs and endoscopic treatments are the current mainstays of the therapeutic approach. Treatment with proton pump inhibitors (or antireflux surgery) should be considered in patients with Barrett's esophagus, since a recent meta-analysis demonstrated a 71% reduction in risk of neoplastic progression. Endoscopic resection combined with radiofrequency ablation is the standard of care in patients with early esophageal adenocarcinoma. Mucosal squamous cancer may also be treated endoscopically, preferably with endoscopic submucosal dissection. Patients with upper esophageal cancer often refrain from surgery. Robot-assisted, thoracolaparoscopic, minimally invasive esophagectomy may be an appropriate option for these patients, as the robot facilitates a good overview of the upper mediastinum. Induction chemoradiotherapy is currently considered as standard treatment for patients with advanced squamous cell carcinoma, while the role of neoadjuvant therapy for adenocarcinoma remains controversial. A system for defining and recording perioperative complications associated with esophagectomy has been recently developed and may help to find predictors of mortality and morbidity.

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Outcome, complications, and mortality of an intrathoracic anastomosis in esophageal cancer in patients without a preoperative selection with a risk score

Cited by 22 publications

References 41 publications

Conditional survival after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer

Conditional survival after neoadjuvant chemoradiotherapy and surgery for oesophageal cancer

A bridging stent to surgery in patients with esophageal and gastroesophageal junction cancer has a dramatic negative impact on patient survival

Current treatment options for esophageal diseases

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