The association between postoperative complications and long-term survival after esophagectomy: a multicenter cohort study
Fransen, Laura F C; Verhoeven, Rob H A; Janssen, Thijs H J B; van Det, Marc J; Gisbertz, Suzanne S; van Hillegersberg, Richard; Klarenbeek, Bastiaan; Kouwenhoven, Ewout A; Nieuwenhuijzen, Grard A P; Rosman, Camiel; Ruurda, Jelle P; van Berge Henegouwen, Mark I; Luyer, Misha D P
(2023) Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus, volume 36, issue 6, pp. 1 - 11
(Article)
Abstract
Conflicting results are reported on the association between post-esophagectomy complications and long-term survival. This multicenter study assesses the association between complications after an esophagectomy and long-term overall survival. Five Dutch high-volume centers collected data from consecutive patients undergoing esophagectomy between 2010 and 2016 and merged these with long-term survival data
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from the Netherlands Cancer Registry. Exclusion criteria were non-curative resections and 90-day mortality, among others. Primary outcome was overall survival related to the presence of a postoperative complication in general. Secondary outcomes analyzed the presence of anastomotic leakage and cardiopulmonary complications. Propensity score matching was performed and the outcomes were analyzed via Log-Rank test and Kaplan Meier analysis. Among the 1225 patients included, a complicated course occurred in 719 patients (59.0%). After matching for baseline characteristics, 455 pairs were successfully balanced. Patients with an uncomplicated postoperative course had a 5-year overall survival of 51.7% versus 44.4% in patients with complications (P = 0.011). Anastomotic leakage occurred in 18.4% (n = 226), and in 208 matched pairs, it was shown that the 5-year overall survival was 57.2% in patients without anastomotic leakage versus 44.0% in patients with anastomotic leakage (P = 0.005). Overall cardiopulmonary complication rate was 37.1% (n = 454), and in 363 matched pairs, the 5-year overall survival was 52.1% in patients without cardiopulmonary complications versus 45.3% in patients with cardiopulmonary complications (P = 0.019). Overall postoperative complication rate, anastomotic leakage, and cardiopulmonary complications were associated with a decreased long-term survival after an esophagectomy. Efforts to reduce complications might further improve the overall survival for patients treated for esophageal carcinoma.
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Keywords: Anastomotic Leak/epidemiology, Carcinoma, Squamous Cell/surgery, Cohort Studies, Esophageal Neoplasms/pathology, Esophagectomy/adverse effects, Humans, Postoperative Complications/epidemiology, Retrospective Studies, esophagectomy, long-term survival, postoperative complication, General Medicine, Multicenter Study, Journal Article
ISSN: 1120-8694
Publisher: Wiley-Blackwell
Note: Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved.
(Peer reviewed)