Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer

• Published in: BJS open 2020-06, Vol.4 (3), p.405-415
• Main Authors: Bundred, J. R., Hollis, A. C., Evans, R., Hodson, J., Whiting, J. L., Griffiths, E. A.
• Format: Article
• Language: English
• Subjects: Audit departments; Cancer therapies; Chemotherapy; Chronic obstructive pulmonary disease; Endoscopy; Esophageal cancer; Esophagus; Hospitals; Morbidity; Mortality; Original; Ostomy; Patients; Surgery; Upper GI; Variables
• ISSN: 2474-9842; 2474-9842
• DOI: 10.1002/bjs5.50264

Background Recent evidence suggests that complications after oesophagectomy may decrease short‐ and long‐term survival of patients with oesophageal cancer. This study aimed to analyse the impact of complications on survival in a Western cohort. Methods Complications after oesophagectomy were recorded for all patients operated on between January 2006 and February 2017, with severity defined using the Clavien–Dindo classification. Associations between complications and overall and recurrence‐free survival were assessed using univariable and multivariable Cox regression models. Results Of 430 patients, 292 (67·9 per cent) developed postoperative complications, with 128 (39·8 per cent) classified as Clavien–Dindo grade III or IV. No significant associations were detected between Clavien–Dindo grade and either tumour (T) (P = 0·071) or nodal (N) status (P = 0·882). There was a significant correlation between Clavien–Dindo grade and ASA fitness grade (P = 0·032). In multivariable analysis, overall survival in patients with Clavien–Dindo grade I complications was similar to that in patients with no complications (hazard ratio (HR) 0·97, P = 0·915). However, patients with grade II and IV complications had significantly shorter overall survival than those with no complications: HR 1·64 (P = 0·007) and 1·74 (P = 0·013) respectively. Conclusion Increasing severity of complications after oesophagectomy was associated with decreased overall survival. Prevention of complications should improve survival. Antecedentes Evidencias recientes sugieren que las complicaciones después de la esofaguectomía pueden reducir la supervivencia a corto y a largo plazo de los pacientes con cáncer de esófago. Este estudio tenía como objetivo analizar el impacto de las complicaciones sobre la supervivencia en una cohorte occidental. Métodos Entre enero de 2006 y febrero de 2017, se recogieron las complicaciones tras la esofaguectomía de todos los pacientes, con la gravedad de dichas complicaciones definida según los grados de Clavien. Se evaluaron las asociaciones entre las complicaciones y las supervivencias global y libre de recidiva utilizando modelos de regresión de Cox univariable y multivariable. Resultados De 430 pacientes, 292 (68%) desarrollaron complicaciones postoperatorias, con 128 (30%) clasificadas como Clavien‐Dindo grado 3 o 4. No se detectaron asociaciones significativas entre los grados de Clavien‐Dindo y el estadio tumoral (T) o ganglionar (N) (P = 0,071, P = 0,882). Hub