Abstract
BackgroundIt has been postulated that the hyperadrenergic state caused by surgical trauma is associated with worse outcomes and that β-blockade may improve overall outcome by downregulation of adrenergic activity. Esophageal resection is a surgical procedure with substantial risk for postoperative mortality. There is insufficient data to extrapolate the existing association between preoperative β-blockade and postoperative mortality to esophageal cancer surgery. This study assessed whether preoperative β-blocker therapy affects short-term postoperative mortality for patients undergoing esophageal cancer surgery.MethodsAll patients with an esophageal cancer diagnosis that underwent surgical resection with curative intent from 2007 to 2017 were retrospectively identified from the Swedish National Register for Esophagus and Gastric Cancers (NREV). Patients were subdivided into β-blocker exposed and unexposed groups. Propensity score matching was carried out in a 1:1 ratio. The outcome of interest was 90-day postoperative mortality.ResultsA total of 1466 patients met inclusion criteria, of whom 35% (n = 513) were on regular preoperative β-blocker therapy. Patients on β-blockers were significantly older, more comorbid and less fit for surgery based on their ASA score. After propensity score matching, 513 matched pairs were available for analysis. No difference in 90-day mortality was detected between β-blocker exposed and unexposed patients (6.0% vs. 6.6%, p = 0.798).ConclusionPreoperative β-blocker therapy is not associated with better short-term survival in patients subjected to curative esophageal tumor resection.
Highlights
It has been postulated that the hyperadrenergic state caused by surgical trauma is associated with worse outcomes and that β-blockade may improve overall outcome by downregulation of adrenergic activity
A special aspect of esophageal cancer surgery, compared to other cancer surgeries, is the use of postoperative epidural thoracic analgesia (TEA), which has independently been associated with a decrease in postoperative morbidity [9]
Patient identification Following ethical approval from the Regional Review Board (Ref. 2018–361, Uppsala County, Sweden), all patients diagnosed with esophageal cancer from 1 January 2007 to 31 December 2017 were identified from the Swedish National Register for Esophagus and Gastric Cancers (NREV)
Summary
It has been postulated that the hyperadrenergic state caused by surgical trauma is associated with worse outcomes and that β-blockade may improve overall outcome by downregulation of adrenergic activity. Several studies have shown significant benefits of β-blocker therapy in the context of non-cardiac surgery in which β-blocker treatment reduces adverse postoperative events with a significant decrease in postoperative mortality [5,6,7,8]. A special aspect of esophageal cancer surgery, compared to other cancer surgeries, is the use of postoperative epidural thoracic analgesia (TEA), which has independently been associated with a decrease in postoperative morbidity [9]. This nationwide cohort study aims to investigate the association between regular preoperative β-blocker therapy and 90-day all-cause mortality after esophageal resection surgery for cancer. The authors hypothesize that β-blocker exposure would be associated with a reduced risk of mortality following esophageal cancer resection
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