PP39 - Survival after prolonged ICU stay in patients who have had surgical resection of oesophageal squamous cell carcinoma

Abstract

Oesophageal squamous-cell carcinoma (SCC) is associated with lifestyle-related behaviours (i.e. malnutrition, alcohol and tobacco), which also increase the risk of perioperative complications (1,2). Previously the impact of complications on survival has been explored in mixed SCC and adenocarcinoma populations with conflicting results. In the present study, the influence of perioperative complications on survival following open oesophageal resection was investigated exclusively in patients with SCC. In a retrospective observational study at the department of cardiothoracic surgery and intensive care unit (ICU) at Rigshospitalet, Copenhagen, Denmark, 133 patients were included. Patients undergoing open surgical resection from February 2010 to December 2015 were consecutively included. Pre- and perioperative clinical information, mortality and complications defined as a Clavien-Dindo classification >1 were registered. The overall survival was calculated from time of index surgery to the censoring date November 16 2016. Primary outcome was overall survival. Secondary outcomes were short-term survival (30 and 90 days respectively), long-term survival (excluding 30 days mortality) and postoperative complications. Eighty-nine patients experienced one or more postoperative complications. The most frequent was suspicion of infection requiring antibiotic treatment (56%) and among these 19% had sepsis. In addition atrial fibrillation (14%), delirium (12%), anastomotic leakage (11%) and chylothorax (6%) were among the most common complications. The incidence of postoperative complications was associated with a low haemoglobin level (P<0.001) and a low mean arterial pressure in the ICU (P=0.015) and during the operation (P=0.030). Short-term survival was not significantly different in patients with or without complications. However, long-term survival was significantly lower in patients with complications (log rank P=0.038). Patients with a length of stay in the ICU ≥ 20 days had a significantly lower overall survival (log rank P<0.001) (Figure 1). After one year 71% were dead, compared with 14% in the group requiring less than 20 days in the ICU. A univariate Cox regression analysis revealed that long-term survival was significantly worse in patients experiencing complications (HR: 2.07, 95% CI: 1.02-4.21, P=0.044), and overall survival was lower in patients admitted for ≥20 days in the ICU (HR: 6.97, 95% CI: 2.61-18.59, P<0.001). We found that survival was negatively affected by complications during the index hospitalisation for SCC resection and in patients requiring an ICU stay for 20 days or more. Additional follow-up studies are necessary to clearly identify markers for compassionate treatment in this high risk patient group. 1. Pennathur A, Gibson MK, Jobe BA, Luketich JD. Oesophageal carcinoma. Lancet (London, England). 2013; 381(9864): 400-12. 2. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA: a cancer journal for clinicians. 2015; 65(2): 87-108.