Complications after esophagectomy may not impact survival of esophageal cancer patients
Complications from esophagectomy did not result in significant decreases to overall survival among patients with esophageal cancer, while tumor characteristics and certain procedure types did, according to recent study results.
Researchers evaluated data from 237 patients who received curative esophagogastrectomy for cancer between 1994 and 2008. Procedures performed included Ivor-Lewis, transhiatal, 3-hole and minimally invasive esophagectomy. Incidence of complications and survival rates was recorded, and potential predictive factors were assessed.
Tumors were primarily located in the gastroesophageal junction (44.7%) and distal esophagus (33.8%), and adenocarcinoma was identified in 84.8% of cases. The most common procedure performed was transhiatal esophagectomy (46.4%), with 24.5% receiving Ivor-Lewis and 11.0% undergoing minimally invasive procedures. Negative margin resection occurred in 89.5% of patients, and R1 resection was achieved in 6.8%.
More than half of patients (57.8%) experienced postoperative complications. Complication grades were: 42.2% of patients had no complications (grade 0, Clavien scale), 27.5% experienced minor complications (grades 1 and 2) and 30.5% experienced major complications and/or mortality (grades 3 through 5). Perioperative death occurred in 5.1% of patients. Common complications included respiratory failure requiring intubation (14.8%), supraventricular arrhythmia (14.3%), anastomotic leakage (13.5%) and pleural effusion (12.7%).
Among patients who experienced complications, median survival time was 20.8 months. No association was observed between overall survival and complication grade (P=.095), but patients with serious complications (grade 4) had a nonsignificant decrease in survival (P=.15).
Survival was associated with the type of procedure performed (P=.0004) and pathologic stage (P=.0007) via multivariate analysis. Patients who underwent 3-hole (RR=0.55; 95% CI, 0.22-1.41) and minimally invasive procedures (RR=0.17; 95% CI, 0.05-0.59) were at significantly reduced risk compared with those who received transhiatal esophagectomy, while Ivor-Lewis recipients faced increased risk (RR=3.56; 95% CI, 1.40-9.08).
“Esophagectomy is a major invasive procedure that can be performed safely at high-volume centers,” the researchers wrote. “Although the procedure is associated with potential postoperative morbidities, postoperative complication rates are reasonable when performed and cared for by an experienced medical team. The impact of major postoperative complications on long-term survival may not be as consequential as previously reported; instead, tumor characteristics at the time of resection may be the most important.”