Abstract
BackgroundRecent evidence suggests that complications after oesophagectomy may decrease short‐ and long‐term survival of patients with oesophageal cancer. This study aimed to analyse the impact of complications on survival in a Western cohort.MethodsComplications after oesophagectomy were recorded for all patients operated on between January 2006 and February 2017, with severity defined using the Clavien–Dindo classification. Associations between complications and overall and recurrence‐free survival were assessed using univariable and multivariable Cox regression models.ResultsOf 430 patients, 292 (67·9 per cent) developed postoperative complications, with 128 (39·8 per cent) classified as Clavien–Dindo grade III or IV. No significant associations were detected between Clavien–Dindo grade and either tumour (T) (P = 0·071) or nodal (N) status (P = 0·882). There was a significant correlation between Clavien–Dindo grade and ASA fitness grade (P = 0·032). In multivariable analysis, overall survival in patients with Clavien–Dindo grade I complications was similar to that in patients with no complications (hazard ratio (HR) 0·97, P = 0·915). However, patients with grade II and IV complications had significantly shorter overall survival than those with no complications: HR 1·64 (P = 0·007) and 1·74 (P = 0·013) respectively.ConclusionIncreasing severity of complications after oesophagectomy was associated with decreased overall survival. Prevention of complications should improve survival.
Highlights
Despite advances in treatment, oesophageal cancer remains the sixth most common cause of cancer-related mortality worldwide, with an increasing incidence in the West[1,2]
Postoperative histological examination revealed that the majority of the 430 patients had either adenocarcinoma (337, 78⋅4 per cent) or squamous cell carcinoma (70, 16⋅3 per cent); the rest had either adenosquamous carcinoma (8, 1⋅9 per cent) or another malignant cancer (15, 3⋅5 per cent)
Complications may lead to increased inflammation, affecting the immune system of patients after surgery and leading to increased production of proinflammatory cytokines such as interleukin (IL) 6 and IL-824
Summary
Oesophageal cancer remains the sixth most common cause of cancer-related mortality worldwide, with an increasing incidence in the West[1,2]. The mainstay of curative therapy for locoregional oesophageal cancer is oesophagectomy, this procedure is possible only in selected patients. Even in this subset, resection is associated with significant morbidity and mortality[3,4]. Recent evidence[3,6,13,14,15,16] suggests that complications after oesophagectomy may decrease overall and disease-specific survival in patients with complications that resolve initially. Recent evidence suggests that complications after oesophagectomy may decrease shortand long-term survival of patients with oesophageal cancer. Conclusion: Increasing severity of complications after oesophagectomy was associated with decreased overall survival.
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