The association between postoperative complications and long-term survival after esophagectomy: a multicenter cohort study

• Published in: Diseases of the esophagus 2023-05, Vol.36 (6)
• Main Authors: 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
• Format: Article
• Language: English
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1093/dote/doac086

Summary 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 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.