Surgical complications and long-term survival after esophagectomy for cancer in a nationwide Swedish cohort study

Abstract

AimsAcute surgical complications after esophageal resection for cancer may decrease the long-term survival. Previous results on this topic are conflicting and no population-based studies are available. MethodsA prospective, nationwide Swedish study was conducted in 2001–2010. Eligible patients comprised those afflicted by esophageal or cardia cancer and underwent surgical resection in Sweden in 2001–2005. Details concerning patient and tumor characteristics, surgical procedures, and postoperative surgical complications were collected prospectively. Follow-up for mortality, starting from 90 days after the surgery, was done until May 2010. Cox proportional-hazards regression was performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for age, tumor stage, sex, histology, comorbidity, surgical approach and surgical radicality. ResultsAmong 567 included patients who survived at least 90 days postoperatively, 130 (22.9%) sustained a predefined surgical complication within 30 days of surgery. The adjusted HR of mortality was increased in patients who sustained surgical complications, compared to patients without such complications (HR 1.29, 95% CI 1.02–1.63). ConclusionsThe occurrence of surgical complications might be an independent predictor for poorer long-term survival in patients resected for esophageal cancer, even in patients who survived the postoperative period.