Abstract
BackgroundNewly developed atrial fibrillation (AF) in patients who have undergone an esophagectomy increases the incidence of postoperative complications. However, the clinical implications of AF have not been fully elucidated in these patients. This retrospective observational study investigated the predictors for AF and the effect of AF on the mortality in esophageal cancer patients undergoing esophagectomy.MethodsThis study evaluated 583 patients undergoing esophagectomy, from January 2005 to April 2012. AF was defined as newly developed postoperative AF requiring treatment. The risk factors for AF and the association between AF and mortality were evaluated. The long-term mortality was the all-cause mortality, for which the cutoff date was May 31, 2014.ResultsAF developed in 63 patients (10.8%). Advanced age (odds ratio [OR] 1.099, 95% confidence interval [CI] 1.056–1.144, P < 0.001), preoperative calcium channel blocker (CCB) (OR 2.339, 95% CI 1.143–4.786, P = 0.020), and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) (OR 0.206, 95% CI 0.067–0.635, P = 0.006) were associated with the incidence of AF. The Kaplan-Meier curve showed a significantly lower survival rate in the AF group compared to the non-AF group (P = 0.045), during a median follow-up of 50.7 months. The multivariable analysis revealed associations between AF and the 1-year mortality (hazard ratio [HR] 2.556, 95% CI 1.430–4.570, P = 0.002) and between AF and the long-term mortality (HR 1.507, 95% CI 1.003–2.266, P = 0.049).ConclusionsIn esophageal cancer patients, the advanced age and the preoperative medications (CCB, ACEI or ARB) were associated with the incidence of AF. Furthermore, postoperatively developed AF was associated with mortality in esophageal cancer patients after esophagectomy, suggesting that a close surveillance might be required in patients who showed AF during postoperative period.
Highlights
Esophageal cancer is the eighth most common cancer worldwide, demonstrating a poor prognosis [1]
Advanced age, preoperative calcium channel blocker (CCB), and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) were associated with the incidence of Atrial fibrillation (AF)
The multivariable analysis revealed associations between AF and the 1-year mortality and between AF and the long-term mortality (HR 1.507, 95% confidence intervals (CIs) 1.003–2.266, P = 0.049)
Summary
Esophageal cancer is the eighth most common cancer worldwide, demonstrating a poor prognosis [1]. The effects of AF following esophagectomy have not been fully evaluated, despite a substantially unfavourable burden of AF. This might be due to a lack of data from studies that exclusively enrolled patients undergoing esophageal cancer surgery, without other non-cardiac thoracic surgeries. Developed atrial fibrillation (AF) in patients who have undergone an esophagectomy increases the incidence of postoperative complications. The clinical implications of AF have not been fully elucidated in these patients This retrospective observational study investigated the predictors for AF and the effect of AF on the mortality in esophageal cancer patients undergoing esophagectomy
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