Abstract
Effective and adequate opioid use and prevention of postoperative complications are important for enhanced recovery after surgery. We examined the effects of postoperative opioid use and postoperative complications on overall survival and recurrence-free survival after esophageal cancer surgery. This retrospective cohort study analyzed the records of patients diagnosed with esophageal cancer who underwent the Ivor Lewis operation between January 2005 and December 2011. We collected data on total opioid use for 8 days postoperatively, as well as information on postoperative complications (Clavien-Dindo classification). One hundred and twenty-one patients were included in the final analysis. Total opioid use was not significantly associated with overall survival (p = 0.520) and recurrence-free survival (p = 0.818). In contrast, the hazard ratio of postoperative overall survival was significantly higher with respect to Clavien-Dindo classification 1–2 (hazard ratio: 2.009, p = 0.046), 3a–3b (hazard ratio: 5.759, p < 0.001), and 4a–5 (hazard ratio: 3.982, p = 0.020) complications compared to no complications. Additionally, the hazard ratio of the recurrence-free survival was significantly higher in class 1–2 complications (hazard ratio: 2.336, p = 0.028) compared to none. Our study demonstrates that postoperative opioid use is not associated with survival and recurrence-free survival after esophageal cancer surgery, while postoperative complications may increase the hazard ratio for survival and recurrence-free survival.
Highlights
Esophageal cancer is a highly fatal cancer, with the sixth highest cancer-related mortality rate [1] research data on esophageal cancer is limited compared to that of other cancers [2]
The following data were collected from the patients: sex, age, weight, height, postoperative complications, Clavien-Dindo classification of postoperative complications, location and histologic type of tumor, tumor and lymph node status, adjuvant chemotherapy history, adjuvant radiotherapy history, American Society of Anesthesiologists (ASA) classification, operation time, length of hospital stay, intensive care unit readmission, epidural analgesia, date of death, date of recurrence, intraoperative remifentanil dose, and opioid use in the first 8 postoperative days (PODs) (POD 0–7)
Our study demonstrates that total opioid use from POD 0–7 and the additional intraoperative use of remifentanil did not affect the postoperative overall survival (OS) and recurrence-free survival (RFS) of patients with esophageal cancer
Summary
Esophageal cancer is a highly fatal cancer, with the sixth highest cancer-related mortality rate [1] research data on esophageal cancer is limited compared to that of other cancers [2]. Curative resection is recommended for both limited (T1-2, N0-1, M0) and advanced (T3-4, N0-1, M0). The recurrence rate remains high even after a successful curative resection, and long-term survival rate remains below 25% [4]. Enhanced recovery after surgery (ERAS), an important care pathway to effectively facilitate early recovery in postoperative patients, has short-term benefits including reduced hospital stay after esophageal cancer surgery [5]. Two key components of ERAS are the maintenance of effective pain control while reducing excessive opioid use and a reduction of postoperative complications. Opioids are reported to increase cancer recurrence after surgery by inducing immunosuppression through their effects on natural killer cell activity [6]. Postoperative complications are reported to be associated with overall survival (OS) and recurrence rates [7,8].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
