Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2017

01-03-2017 | Gastrointestinal Oncology

Esophageal Cancer Surgery for Patients with Concomitant Liver Cirrhosis: A Single-Center Matched-Cohort Study

Authors: Michele Valmasoni, MD, PhD, Elisa Sefora Pierobon, MD, Carlo Alberto De Pasqual, MD, Gianpietro Zanchettin, MD, Lucia Moletta, MD, Renato Salvador, MD, FACS, Mario Costantini, MD, Alberto Ruol, MD, FACS, Stefano Merigliano, MD

Published in: Annals of Surgical Oncology | Issue 3/2017

Login to get access

Abstract

Background

Cirrhosis is a risk factor with nonhepatic surgery, but only three series regarding esophagectomy are reported. The Model for End-Stage Liver Disease (MELD) score has shown benefit in risk evaluation, but there is no experience regarding esophagectomy. This study aimed to compare the outcomes of surgery for esophageal cancer between cirrhotic and noncirrhotic patients and to evaluate whether the MELD score has a prognostic value for risk stratification.

Methods

From the authors’ esophageal cancer database, they selected all the patients with concomitant cirrhosis who underwent surgery with curative intent and a matched cohort of patients without cirrhosis. The preoperative data included demographics, medical history, blood work, American Society of Anesthesiologists (ASA) score, Child-Turcotte-Pugh (CTP) score, and MELD score. The operative data included type of surgery, radicality, operative time, and blood loss. The postoperative data included hemoderivatives, 90-day morbidity and mortality rates, lab works, and hospital length of stay. The cirrhotic patients were further divided and analyzed according to a MELD score cutoff of 9.

Results

Of 3445 esophageal cancer patients, 73 cirrhotic patients underwent surgery. Their 90-day morbidity and mortality rates were higher than those for 146 noncirrhotic patients. The cirrhotic patients also had more respiratory events (p = 0.013) and infections (p = 0.005). The anastomotic complications among the cirrhotic patients were significantly more severe (p = 0.046). No difference in 5-year survival rates was registered. Stratification according to the MELD score showed that patients with a MELD score higher than 9 had a significantly worse postoperative course (5-year survival: p = 0.004). The patients with a MELD score of 9 or lower showed an outcome similar to that of the noncirrhotic patients.

Conclusions

Liver cirrhosis is not an absolute contraindication to esophagectomy. The MELD score can be applicable for esophagectomy risk assessment for cirrhotic patients.
Literature
1.
2.
Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods, and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.CrossRefPubMed
3.
4.
Blachier M, Leleu H, Peck-Radosavljevic M, et al. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58:593–608.CrossRefPubMed
5.
Trivin F, Boucher E, Vauléon E, et al. Management of esophageal carcinoma associated with cirrhosis: a retrospective case-control analysis. J Oncol. 2009;2009:173421–5.CrossRefPubMedPubMedCentral
6.
Dagnini G, Caldironi MW, Marin G, et al. Laparoscopy in abdominal staging of esophageal-carcinoma: report of 369 cases. Gastrointest Endosc. 1986;32:400–2.CrossRefPubMed
7.
Kalaitzakis E, Gunnarsdottir SA, Josefsson A, et al. Increased risk for malignant neoplasms among patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9:168–74.CrossRefPubMed
8.
Simmelink AL, Dong R, Nayi V, et al. Perioperative risk assessment and management of cirrhotic patients. J Hepatol Gastroint. 2015;1:1.
9.
Bhangui P, Laurent A, Amathieu R, et al. Assessment of risk for nonhepatic surgery in cirrhotic patients. J Hepatol. 2012;57:874–84.CrossRefPubMed
10.
Sabbagh C, Fuks D, Regimbeau JM. Nonhepatic gastrointestinal surgery in patients with cirrhosis. J Visc Surg. 2014;151:203–11.CrossRefPubMed
11.
Fekete F, Belghiti J, Cherqui D, et al. Results of esophagogastrectomy for carcinoma in cirrhotic patients: a series of 23 consecutive patients. Ann Surg. 1987;206:74–8.CrossRefPubMedPubMedCentral
12.
Tachibana M, Kotoh T, Kinugasa S, et al. Esophageal cancer with cirrhosis of the liver: results of esophagectomy in 18 consecutive patients. Ann Surg Oncol. 2000;7:758–63.CrossRefPubMed
13.
Lu M-S, Liu Y-H, Wu Y-C, et al. Is it safe to perform esophagectomy in esophageal cancer patients combined with liver cirrhosis? Interact Cardiovasc Thorac Surg. 2005;4:423–5.CrossRefPubMed
14.
Belghiti J, Cherqui D, Gayet B, et al. Esophagectomy for esophageal cancer in the cirrhotic. Gastroenterol Clin Biol. 1987;11(2BIS):A118–8.
15.
Salerno F, Merli M, Cazzaniga M, et al. MELD score is better than Child–Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol. 2002;36:494–500.CrossRefPubMed
16.
17.
Northup PG, Wanamaker RC, Lee VD, et al. Model for end-stage liver disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis. Ann Surg. 2005;242:244.CrossRefPubMedPubMedCentral
18.
Neeff H, Mariaskin D, Spangenberg H-C, et al. Perioperative mortality after nonhepatic general surgery in patients with liver cirrhosis: an analysis of 138 operations in the 2000s using Child and MELD scores. J Gastrointest Surg. 2011;15:1–11.CrossRefPubMed
19.
Roayae A, Jibara G, Tabrizian P, et al. The role of hepatic resection in the treatment of hepatocellular cancer. Hepatology. 2015;62:440–51.CrossRef
20.
Greene FL, Page DL, Fleming ID, et al (eds). AJCC cancer staging manual. 6th ed. Springer, New York, 2002.
21.
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral
22.
Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy Esophagectomy Complications Consensus Group (ECCG). Ann Surg. 2015;262:286–94.CrossRefPubMed
23.
Mariette B, Piessen G, Balon JM, et al. Surgery alone in the curative treatment of localised oesophageal carcinoma. Eur J Surg Oncol. 2004;30:869–76.CrossRefPubMed
24.
Bailey SH, Bull DA, Harpole DH, et al. Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg. 2003;75:217–22.CrossRefPubMed
25.
Mariette C, Piessen G, Lamblin A, et al. Impact of preoperative radiochemotherapy on postoperative course and survival in patients with locally advanced squamous cell oesophageal carcinoma. Br J Surg. 2006;93:1077–83.CrossRefPubMed
26.
Liverani A, Solinas L, Di Cesare T, et al. Preoperative transjugular portosystemic shunt for oncological gastric surgery in a cirrhotic patient. World J Gastroenterol. 2015;21:997–1000.CrossRefPubMedPubMedCentral
27.
Christou L, Pappas G, Falagas ME. Bacterial infection-related morbidity and mortality in cirrhosis. Am J Gastroenterol. 2007;102:1510–7.CrossRefPubMed
28.
Fernández J, Acevedo J. New antibiotic strategies in patients with cirrhosis and bacterial infection. Expert Rev Gastroenterol Hepatol. 2015;9:1495–500.CrossRefPubMed
Metadata
Title
Esophageal Cancer Surgery for Patients with Concomitant Liver Cirrhosis: A Single-Center Matched-Cohort Study
Authors
Michele Valmasoni, MD, PhD
Elisa Sefora Pierobon, MD
Carlo Alberto De Pasqual, MD
Gianpietro Zanchettin, MD
Lucia Moletta, MD
Renato Salvador, MD, FACS
Mario Costantini, MD
Alberto Ruol, MD, FACS
Stefano Merigliano, MD
Publication date
01-03-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5610-8

Other articles of this Issue 3/2017

Annals of Surgical Oncology 3/2017 Go to the issue

Gastrointestinal Oncology

Increasing the Number of Examined Lymph Nodes is a Prerequisite for Improvement in the Accurate Evaluation of Overall Survival of Node-Negative Gastric Cancer Patients

Healthcare Policy and Outcomes

Postoperative Complications and Long-Term Survival After Complex Cancer Resection

Breast Oncology

Is Routine Axillary Imaging Necessary in Clinically Node-Negative Patients Undergoing Neoadjuvant Chemotherapy?

Breast Oncology

Extending ACOSOG Z0011 to Encompass Mastectomy: What Happens Without RT?

Healthcare Policy and Outcomes

Cancer Research in Low- and Middle-Income Countries: Consortiums, Implementation Science and Healthcare Delivery

Head and Neck Oncology

Clinical Outcomes of Taiwanese Patients with cT4 Oral Cavity Squamous Cell Carcinoma: Toward the Identification of the Optimal Initial Treatment Approach for cT4b Patients