Patient-Related Prognostic Factors for Anastomotic Leakage, Major Complications, and Short-Term Mortality Following Esophagectomy for Cancer: A Systematic Review and Meta-Analyses

Abstract

Objective The aim of this study is to identify preoperative patient-related prognostic factors for anastomotic leakage, mortality, and major complications in patients undergoing oncological esophagectomy. Background Esophagectomy is a high-risk procedure with an incidence of major complications around 25% and short-term mortality around 4%. Methods We systematically searched the Medline and Embase databases for studies investigating the associations between patient-related prognostic factors and anastomotic leakage, major postoperative complications (Clavien–Dindo ≥ IIIa), and/or 30-day/in-hospital mortality after esophagectomy for cancer. Results Thirty-nine eligible studies identifying 37 prognostic factors were included. Cardiac comorbidity was associated with anastomotic leakage, major complications, and mortality. Male sex and diabetes were prognostic factors for anastomotic leakage and major complications. Additionally, American Society of Anesthesiologists (ASA) score > III and renal disease were associated with anastomotic leakage and mortality. Pulmonary comorbidity, vascular comorbidity, hypertension, and adenocarcinoma tumor histology were identified as prognostic factors for anastomotic leakage. Age > 70 years, habitual alcohol usage, and body mass index (BMI) 18.5–25 kg/m2 were associated with increased risk for mortality. Conclusions Various patient-related prognostic factors are associated with anastomotic leakage, major postoperative complications, and postoperative mortality following oncological esophagectomy. This knowledge may define case-mix adjustment models used in benchmarking or auditing and may assist in selection of patients eligible for surgery or tailored perioperative care.

Conventional regression analysis and machine learning in prediction of anastomotic leakage and pulmonary complications after esophagogastric cancer surgery

“…In line with current literature, our study has demonstrated that ASA score ≥III is associated with anastomotic leakage and pulmonary complications 17,19 . Both patients with advanced age and high ASA classification are thought to have lower healing capacity causing higher susceptibility to postoperative complications.…”

The Implementation of Minimally Invasive Surgery in the Treatment of Esophageal Cancer: A Step Toward Better Outcomes?

“…Another concern is the objective assessment of the postoperative complications, which remained scarce until recently (i.e., anastomotic leak, pulmonary complications). Lately, this has been addressed and refined through benchmarking and audits originating from high-volume centers and experts in the field [39][40][41]. Therefore, the implementation of common tools and strategies in the assessment of the postoperative results among the different centers can now be pursued and achieved.…”

Treatment Options for Patients With Persistent Disease After Initial Endotherapy for Esophageal Neoplasia

“…24 Each patient's unique profile of comorbidities must also be evaluated, but few are absolute contraindications to esophagectomy. Cardiorespiratory disease, 25 liver cirrhosis, 26,27 renal failure, 28,29 and diabetes 30 are examples of comorbidities that are associated with increased perioperative risk in esophagectomy but can be managed in select patients to permit safe surgery. In addition, patient anatomy, past history of surgery and radiation may have a major impact on the complexity of esophagectomy surgery and reconstruction.…”