The Impact of Severe Anastomotic Leak on Long-term Survival and Cancer Recurrence After Surgical Resection for Esophageal Malignancy

Markar, Sheraz R.; Gronnier, Caroline; Duhamel, Alain; Mabrut, Jean‐Yves; Bail, Jean‐Pierre; Carrère, Nicolas; Lefèvre, Jérémie H.; Brigand, Cécile; Vaillant, Jean‐Christophe; Adham, Mustapha; Msika, Simon; Demartines, Nicolas; Nakadi, Issam El; Meunier, Bernard; Collet, Denis; Mariette, C.

doi:10.1097/sla.0000000000001011

Cited by 244 publications

(171 citation statements)

References 89 publications

Supporting

Mentioning

156

Contrasting

Unclassified

Order By: Relevance

“…Tsujimoto and Tokunaga et al reported a poor long-term outcome due to postoperative infectious complications in stage II and III gastric cancer, but not stage I, which showed similar tendency to our present study [2,26]. Recently, Markar et al reported that loco-regional recurrence, but not distant recurrence was driven by severe anastomotic leakage in patients with esophageal cancer [27]. Meta-analysis for patients with colorectal cancer who received curative surgical resection revealed that anastomotic leakage impacted local recurrence, while there was no association between anastomotic leakage and distant recurrence [28].…”

Section: Discussionsupporting

confidence: 91%

Postoperative infectious complications-driven recurrence after radical resection for esophageal cancer

et al. 2016

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 91%

Postoperative infectious complications-driven recurrence after radical resection for esophageal cancer

et al. 2016

View full text Add to dashboard Cite

“…Proximal margin length more than 5 cm in vivo was demonstrated to be an independent prognostic factor in R0 and R1 resection of esophageal cancer [30]. Preoperative morbidities, especially severe anastomotic leakage, could have an adverse effect on OS, DFS, and even locoregional recurrence [31]. A similar phenomenon was found in a meta-analysis of colorectal cancer [32].…”

Section: Discussionmentioning

confidence: 85%

A prognostic nomogram for overall survival after neoadjuvant radiotherapy or chemoradiotherapy in thoracic esophageal squamous cell carcinoma: a retrospective analysis

et al. 2017

View full text Add to dashboard Cite

BackgroundCurrently, the AJCC staging system or pathological complete response (pCR) are considered not sufficiently accurate to evaluate the survival of patients with esophageal squamous cell carcinoma after neoadjuvant radiotherapy or chemoradiotherapy. This study aimed to establish a nomogram and a recursive partitioning analysis (RPA) model to estimate prognosis and to provide advice for subsequent treatments.MethodsWe analyzed retrospectively 407 patients that were diagnosed with thoracic esophageal squamous cell carcinoma (TESCC) and received neoadjuvant radiotherapy or chemoradiotherapy. Hazard ratios and 95% confidence intervals of categorical clinicopathological characteristics with overall survival (OS) were calculated using the Cox proportional hazard model. The nomogram and RPA model were then established and total scores according to each variable were calculated and stratified to predict OS.ResultsPatients were followed-up over a median 49.9 months. AJCC did not perform well in distinguishing OS among each stage except for IIB and IIIA. Patients were divided into 4 groups according to the total scores based on nomogram (low risk: ≤180; intermediate risk: 180-270; high risk: 270-340; very high risk: >340). The 5-year OS was 57.3%, 40.7%, 18.3%, 6.1% respectively (p<0.05). RPA model also divide the patients into 4 groups, though group2 and group3 were not statistically significant (p=0.574).ConclusionThe nomogram is a good evaluation model for estimating the prognosis of patients with TESCC after neoadjuvant radiotherapy or chemoradiotherapy compared with the AJCC and RPA. The results of this study also suggested that the high-risk subgroups need further treatments.

show abstract

“…In contrast to our study, they found that both disease-free and overall survival were negatively impacted by postoperative leak, with a 28% increased hazard of death and 35% increased hazard of tumor recurrence during follow-up. (16) They did not balance baseline covariates, which may have influenced their recurrence and survival outcomes.…”

Section: Commentmentioning

confidence: 99%

Cancer Recurrence After Esophagectomy: Impact of Postoperative Infection in Propensity-Matched Cohorts

Tam

Luketich

Winger

et al. 2016

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

Background Postoperative infection increases cancer recurrence and worsens survival for colorectal cancer, but the relationship after esophagectomy for esophagogastric adenocarcinoma is not well-defined. We aimed to determine whether recurrence and survival after minimally invasive esophagectomy for esophagogastric adenocarcinoma were influenced by postoperative infection using propensity-matched analysis. Methods We abstracted data for 810 patients (1997–2010) and defined exposure as at least one in-hospital/30-day infectious complication (n=206; 25%). Using 29 pretreatment/intraoperative variables, patients were propensity score matched (caliper=0.05). Time-to-cancer recurrence and survival (Kaplan-Meier curves, Breslow test), and associated factors (Cox regression with shared frailty) were assessed. Results After propensity-matching (n=167 pairs), median bias across propensity score variables was reduced from 12.9% (p<0.001) to 4.4% (p=1.000). Postoperative infection was not associated with rate (n=60 versus 63; McNemar’s p=0.736) or time to recurrence in those who recurred (median 10.7 versus 11.1 months; Wilcoxon signed-rank p-value=0.455), but was associated with shorter overall survival (n=124 versus 102 deaths; median 26 versus 41 months, Breslow p=0.002). After adjusting for age, body mass index, neoadjuvant therapy, sex, comorbidity score, positive resection margins, pathologic stage, R0 resection and recurrence, postoperative infection was associated with a 44% greater hazard for death (HR 1.44; 95% CI 1.10–1.89). Conclusions In patients with esophagogastric adenocarcinoma, post-esophagectomy infections were not associated with increased rate or earlier time to recurrence when baseline characteristics associated with infection risk were balanced using propensity-matching. Despite this, overall survival was shorter in patients with infectious complications. After adjusting for other important survival predictors, post-esophagectomy continued to be independently associated with worse survival.

show abstract

The Impact of Severe Anastomotic Leak on Long-term Survival and Cancer Recurrence After Surgical Resection for Esophageal Malignancy

Abstract: This large multicenter study provides strong evidence that SEAL adversely impacts cancer prognosis. The mechanism through which SEAL increases local recurrence is an important area for future research.

Cited by 244 publications

References 89 publications

Postoperative infectious complications-driven recurrence after radical resection for esophageal cancer

Postoperative infectious complications-driven recurrence after radical resection for esophageal cancer

A prognostic nomogram for overall survival after neoadjuvant radiotherapy or chemoradiotherapy in thoracic esophageal squamous cell carcinoma: a retrospective analysis

Cancer Recurrence After Esophagectomy: Impact of Postoperative Infection in Propensity-Matched Cohorts

Contact Info

Product

Resources

About