The impact of fatal complications
 on surgical esophagocoloplasty outcome
 in cancer patients

Abstract

Relevance: The impact of esophageal cancer surgery complications on survival rate remains a challenge due to the complications and mortality associated with surgical esophagocoloplasty.
 The purpose of this study was to assess the impact of fatal complications (colonic graft necrosis and pneumonia) on surgical esophagocoloplasty outcomes in cancer patients.
 Results: The analysis included 110 patients treated by colonic esophagoplasty for esophageal carcinomas and gastroesophageal junction carcinomas. The frequency of postoperative complications of degree III-IV according to Clavien-Dindo was 36.4%
 (40/110). Pneumonia developed in 15% (16/110), colonic graft necrosis – in 5% (6/110). Out of all causes of death (pneumonia, graft necrosis, bleeding, pulmonary thromboembolism), only graft necrosis (odds ratio (OR) 21.112 [95% CI 2.751-162.013]
 p=0.003) and pneumonia (OR 15.141 [95% CI 3.225-71.089] p=0.001) were the predictors for 90-days’ mortality. Mortality from
 pneumonia amounted to 37.5% (6/16), from necrosis – 50% (3/6). Median overall survival without pneumonia (n=94) and with
 pneumonia (n=16) was 26.6 and 8.0 months, respectively (plogrank=0.030; pcox=0.034). Median overall survival without graft necrosis (n=104) and with necrosis (n=6) was 26.6 and 3.7 months, respectively (plogrank=0.0001; pcox=0.001). The patients subjected to
 colonic esophagoplasty with planning (n=55) had fewer postoperative complications (56.4% [31/55] vs. 16.4% [9/55], p<0.0001),
 lower risk of their development (OR 0.151, 95% CI 0.0620.369, p<0.0001), higher overall 10-year survival (26.0% vs. 17.7%) and
 median survival (49.8 vs. 17.4 months, plogrank=0.038, pcox=0.041).
 Conclusions: Postoperative development of pneumonia or colonic graft necrosis is associated with a significant deterioration in treatment outcomes. Improving the surgical management of cancer patients who require esophagocoloplasty
 has the potential to improve long-term survival.