Predictors of Failure to Rescue After Esophagectomy

Liou, Douglas Z.; Serna‐Gallegos, Derek; Mirocha, James; Bairamian, Vahak J.; Alban, Rodrigo F.; Soukiasian, Harmik J.

doi:10.1016/j.athoracsur.2017.10.022

Cited by 38 publications

(31 citation statements)

References 40 publications

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“…This latter scenario is in line with the concept of rescuing patients from severe complications. From this perspective, other factors beyond the occurrence of a severe complication such as ML need to be considered: for example, the surgeon and hospital volume[29], the nurse-to-patient ratio, and the multidisciplinary approach to the treatment of the complication can definitely be important in reducing the mortality rate[30].…”

Section: Discussionmentioning

confidence: 99%

Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks study

Fumagalli¹,

Baiocchi²,

Celotti³

et al. 2019

WJG

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BACKGROUNDMediastinal leakage (ML) is one of the most feared complications of esophagectomy. A standard strategy for its diagnosis and treatment has been difficult to establish because of the great variability in their incidence and mortality rates reported in the existing series.AIMTo assess the incidence, predictive factors, treatment, and associated mortality rate of mediastinal leakage using the standardized definition of mediastinal leaks recently proposed by the Esophagectomy Complications Consensus Group (ECCG).METHODSSeven Italian surgical centers (five high-volume, two low-volume) affiliated with the Italian Society for the Study of Esophageal Diseases designed and implemented a retrospective study including all esophagectomies (n = 501) with intrathoracic esophagogastric anastomosis performed from 2014 to 2017. Anastomotic MLs were defined according to the classification recently proposed by the ECCG.RESULTSFifty-nine cases of ML were recorded, yielding an overall incidence of 11.8% (95%CI: 9.1%-14.9%). The surgical approach significantly influenced the occurrence of ML: the proportion of leakage was 10.5% and 9% after open and hybrid esophagectomy (HE), respectively, and doubled (20%) after totally minimally invasive esophagectomy (TMIE) (P = 0.016). No other predictive factors were found. The 30- and 90-d overall mortality rates were 1.4% and 3.2%, respectively; the 30- and 90-d leak-related mortality rates were 5.1% and 10.2%, respectively; the 90-d mortality rates for TMIE and HE were 5.9% and 1.8%, respectively. Endoscopy was the first-line treatment in 49% of ML cases, with the need for retreatment in 17.2% of cases. Surgery was needed in 44.1% of ML cases. Endoscopic treatment had the lowest mortality rate (6.9%). Removal of the gastric tube with stoma formation was necessary in 8 (13.6%) cases.CONCLUSIONThe incidence of ML after esophagectomy was high mainly in the TMIE group. However, the general and specific (leak-related) mortality rates were low. Early treatment (surgical or endoscopic) of severe leaks is mandatory to limit related mortality.

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Section: Discussionmentioning

confidence: 99%

Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks study

Fumagalli¹,

Baiocchi²,

Celotti³

et al. 2019

WJG

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“…As hypothesized, esophagectomy induced a rapid drop of albumin, 9,10,12,12,17 which appeared more pronounced in patients who subsequently developed major complications (Figure 1). Present analyses established a cut‐off of ∆Alb at 11 g/L.…”

Section: Discussionmentioning

confidence: 57%

“…Although minimally invasive esophagectomy (MIE) may improve short‐term outcomes, 5,6 esophagectomy remains associated with substantial rates of mortality and severe morbidity, which may compromise long‐term survival 7,8 . Early identification of postoperative complications is of utmost importance, as their systemic impact and subsequent risk of mortality may be reduced if they are promptly detected and treated, especially in elderly or frail patients 9 . In this context, the identification of accurate biomarkers able to predict adverse outcomes early in the postoperative course is of high clinical relevance, as it may help to better anticipate patients’ care and to improve their outcomes.…”

Section: Introductionmentioning

confidence: 99%

Early postoperative decrease of albumin is an independent predictor of major complications after oncological esophagectomy: A multicenter study

Labgaa

Mantziari

Genety

et al. 2020

Journal of Surgical Oncology

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Background and ObjectivesSerum albumin perioperative decrease (∆Alb) may reflect the magnitude of the physiological stress induced by surgery. Studies highlighted its value to predict adverse postoperative outcomes, but data in esophageal surgery are scant. This study aimed to investigate the role of ∆Alb to predict major complications after esophagectomy for cancer.MethodsMulticenter retrospective study conducted in five high‐volume centers, including consecutive patients undergoing an esophagectomy for cancer between 2006 and 2017. Patients were randomly assigned to a training (n = 696) and a validation (n = 350) cohort. Albumin decrease was calculated on postoperative day 1 and defined as ΔAlb. The primary endpoint was major complications according to Clavien classification.ResultsIn the training cohort, esophagectomy induced a rapid drop of albumin. Cut‐off of ΔAlb was established at 11 g/L and allowed to distinguish patients with adverse outcomes. On multivariable analysis, ΔAlb was identified as an independent predictor of major complications (OR, 1.06; 95% CI, 1.01–1.11; p = .014). Higher BMI and laparoscopy were associated with lower ΔAlb. Analysis of the validation cohort provided consistent findings.ConclusionsΔAlb appeared as a promising biomarker after oncological esophagectomy, allowing prediction of potential adverse outcomes.

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“…Our results also showed no association between FFM and short‐term SWL. Patients with an ASA score of 3–4 always suffer from severe systemic diseases and dysfunction before surgery, which appear to affect not only perioperative complications and mortality but also postoperative weight recovery . Previous studies have also investigated the risk factors for SWL after esophagectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with an ASA score of 3-4 always suffer from severe systemic diseases and dysfunction before surgery, which appear to affect not only perioperative complications and mortality but also postoperative weight recovery. [41][42][43] Previous studies have also investigated the risk factors for SWL after esophagectomy. Park et al reported that preoperative weight and postoperative VCP were independent risk factors for weight loss > 10% of PWL one year after esophagectomy.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the associated factors for severe weight loss after minimally invasive McKeown esophagectomy

Wang

Sun

et al. 2018

Thoracic Cancer

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BackgroundThis study investigated the risk factors for severe weight loss (SWL) within one year after minimally invasive McKeown esophagectomy.MethodsEsophageal cancer patients who underwent McKeown esophagectomy between January and July 2017 were prospectively enrolled. Preoperative body weight (PBW) was chosen as the initial body weight.ResultsForty‐four patients were enrolled and successfully followed up for one year. Median weight loss was 7.4% (quartile: 5.3–8.1%) and 12.6% (quartile: 8.8–17.7%) four weeks and one year after surgery, respectively. Accelerated weight loss occurred during the first two weeks after discharge, with median weight loss of 5.6% (quartile: 4.2–7.1%). Multivariable analysis showed that age ≥ 70 years (odds ratio [OR] 7.65; P = 0.030), preoperative sarcopenia (OR 7.18; P = 0.030), the first surgery in the daily schedule (OR 6.87; P = 0.032) and vocal cord paralysis (OR 12.30; P = 0.046) were independent risk factors for short‐term (4 weeks) SWL (> 7.5% PBW), while an American Society of Anesthesiologists score of 3–4 (OR 6.58; P = 0.047), a high fat‐free mass (OR 21.91; P = 0.003), and vocal cord paralysis (OR 25.83; P = 0.017) were independent risk factors for long‐term (1 year) SWL (> 13.0% PBW) after esophagectomy. Postoperative symptoms of insomnia, appetite loss, dysphagia, eating difficulties, and taste issues were also related to SWL.ConclusionsIn esophageal cancer patients who have undergone esophagectomy, the first two weeks after hospital discharge is a key period for nutrition intervention. Patients with associated factors for SWL require postoperative nutrition support.

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Predictors of Failure to Rescue After Esophagectomy

Cited by 38 publications

References 40 publications

Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks study

Incidence and treatment of mediastinal leakage after esophagectomy: Insights from the multicenter study on mediastinal leaks study

Early postoperative decrease of albumin is an independent predictor of major complications after oncological esophagectomy: A multicenter study

Analysis of the associated factors for severe weight loss after minimally invasive McKeown esophagectomy

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