Top

Surgical Endoscopy

Published in:

01-09-2017

The effect of postoperative complications on survival of patients after minimally invasive esophagectomy for esophageal cancer

Authors: Kun-Kun Li, Yin-Jian Wang, Xue-Hai Liu, Qun-You Tan, Yao-Guang Jiang, Wei Guo

Published in: Surgical Endoscopy | Issue 9/2017

Abstract

Background

Minimally invasive esophagectomy (MIE) has been shown to be a feasible technique for the treatment of esophageal cancer; however, its postoperative morbidity remains high. This retrospective study aimed to evaluate the effect of postoperative complications on long-term outcomes in patients who have undergone MIE for esophageal squamous cell carcinoma (ESCC).

Methods

This retrospective study enrolled patients who had undergone MIE for ESCC between September 2009 and November 2014; all procedures were performed by a single surgical team. Relevant patient characteristics and postoperative variables were collected and evaluated. The disease-free survival (DFS) and disease-specific survival (DSS) were determined by the Kaplan–Meier method, and compared by log-rank tests. Possible predictors of survival were subjected to univariate analysis and multivariate Cox proportional hazard regression analysis.

Results

In all, data on 214 patients with ESCC were analyzed, including 170 men and 44 women. All study subjects had undergone thoracoscopic or thoracoscopic–laparoscopic esophagectomy and cervical esophagogastric anastomosis. One hundred and thirty patients (60.7%) had postoperative complications (Grades 1–4). The overall DFS and DSS rates were 80.0 and 88.9% at 1 year, 48.6 and 54.2% at 3 years, and 43.2 and 43.5% at 5 years, respectively. Univariate analysis and multivariate Cox proportional hazard regression analysis showed that T stage, N stage, and tumor grade were independent prognostic factors for long-term survival; however, postoperative complications had no significant effect on the DFS or DSS of this patient cohort (log-rank test, p = 0.354 and 0.160, respectively).

Conclusions

Postoperative complications have no significant effect on long-term survival in patients who have undergone MIE for ESCC.

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A (2015) Global cancer statistics, 2012. CA Cancer J Clin 65:87–108CrossRefPubMed

Tran GD, Sun XD, Abnet CC, Fan JH, Dawsey SM, Dong ZW, Mark SD, Qiao YL, Taylor PR (2005) Prospective study of risk factors for esophageal and gastric cancers in the Linxian general population trial cohort in China. Int J Cancer 113:456–463CrossRefPubMed

Ajani JA (2013) NCCN clinical practice guidelines in oncology, esophageal and esophagogastric junction cancers, v.2.2013. http://www.nccn.org. Accessed 23 July 2013

Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37:7–11PubMed

Dolan JP, Kaur T, Diggs BS, Luna RA, Schipper PH, Tieu BH, Sheppard BC, Hunter JG (2013) Impact of comorbidity on outcomes and overall survival after open and minimally invasive esophagectomy for locally advanced esophageal cancer. Surg Endosc 27:4094–4103CrossRefPubMed

Osugi H, Takemura M, Higashino M, Takada N, Lee S, Kinoshita H (2003) A comparison of video-assisted thoracoscopic oesophagectomy and radical lymph node dissection for squamous cell cancer of the oesophagus with open operation. Br J Surg 90:108–113CrossRefPubMed

Palazzo F, Rosato EL, Chaudhary A, Evans NR, Sendecki JA, Keith S, Chojnacki KA, Yeo CJ, Berger AC (2015) Minimally invasive esophagectomy provides significant survival advantage compared with open or hybrid esophagectomy for patients with cancers of the esophagus and gastroesophageal junction. J Am Coll Surg 220:672–679CrossRefPubMed

Lindner K, Fritz M, Haane C, Senninger N, Palmes D, Hummel R (2014) Postoperative complications do not affect long-term outcome in esophageal cancer patients. World J Surg 38:2652–2661CrossRefPubMed

Xia BT, Rosato EL, Chojnacki KA, Crawford AG, Wekster B, Berger AC (2013) Major perioperative morbidity does not affect long-term survival in patients undergoing esophagectomy for cancer of the esophagus or gastroesophageal junction. World J Surg 37:408–415CrossRefPubMed

10.

Lerut T, Moons J, Coosemans W, Van Raemdonck D, De Leyn P, Decaluwé H, Decker G, Nafteux P (2009) Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence: role of systematic grading of complications using the modified Clavien classification. Ann Surg 250:798–807CrossRefPubMed

11.

Luc G, Durand M, Chiche L, Collet D (2015) Major post-operative complications predict long-term survival after esophagectomy in patients with adenocarcinoma of the esophagus. World J Surg 39:216–222CrossRefPubMed

12.

Rice TW, Blackstone EH, Rusch VW (2010) 7th edition of the AJCC Cancer staging manual: esophagus and esophagogastric junction. Ann Surg Oncol 17:1721–1724CrossRefPubMed

13.

Guo W, Zhao YP, Jiang YG, Niu HJ, Liu XH, Ma Z, Wang RW (2012) Prevention of postoperative chylothoraxwith thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer. Surg Endosc 26:1332–1336CrossRefPubMed

14.

Deng B, Tan QY, Jiang YG, Zhao YP, Zhou JH, Chen GC, Wang RW (2010) Prevention of early delayed gastric emptying after high-level esophagogastrostomy by pyloric digital fracture. World J Surg 34:2837–2843CrossRefPubMed

15.

Guo W, Zou YB, Ma Z, Niu HJ, Jiang YG, Zhao YP, Gong TQ, Wang RW (2013) One surgeon’s learning curve for video-assisted thoracoscopic esophagectomy for esophageal cancer with the patient in lateral positon: how many cases are needed to reach competence? Surg Endosc 27:1346–1352CrossRefPubMed

16.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

17.

Biere SS, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Garcia JR, Gisbertz SS, Klinkenbijl JH, Hollmann MW, de Lange ES, Bonjer HJ, van der Peet DL, Cuesta MA (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379:1887–1892CrossRefPubMed

18.

Ninomiya I, Okamoto K, Fujimura T, Fushida S, Osugi H, Ohta T (2014) Oncologic outcomes of thoracoscopic esophagectomy with extended lymph node dissection: 10-year experience from a single center. World J Surg 38:120–130CrossRefPubMed

19.

Puntambekar SP, Agarwal GA, Joshi SN, Rayate NV, Sathe RM, Patil AM (2010) Thoracolaparoscopy in the lateral position for esophageal cancer: the experience of a single institution with 112 consecutive patients. Surg Endosc 24:2407–2414CrossRefPubMed

20.

Wang H, Feng M, Tan L, Wang Q (2010) Comparison of the short-term quality of life in patients with esophageal cancer after subtotal esophagectomy via video-assisted thoracoscopic or open surgery. Dis Esophagus 23:408–414CrossRefPubMed

21.

Dindo D, Clavien PA (2008) What is a surgical complication? World J Surg 32:939–941CrossRefPubMed

22.

Smithers BM, Gotley DC, Martin I, Thomas JM (2007) Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 245:232–240CrossRefPubMedPubMedCentral

23.

Burdall OC, Boddy AP, Fullick J, Blazeby J, Krysztopik R, Streets C, Hollowood A, Barham CP, Titcomb D (2015) A comparative study of survival after minimally invasive and open oesophagectomy. Surg Endosc 29:431–437CrossRefPubMed

24.

DerHagopian RP, Sugarbaker EV, Ketcham A (1978) Inflammatory oncotaxis. JAMA 240:374–375CrossRefPubMed

25.

Scarpa M, Cavallin F, Saadeh LM, Pinto E, Alfieri R, Cagol M, Da Roit A, Pizzolato E, Noaro G, Pozza G, Castoro C (2015) Hybrid minimally invasive esophagectomy for cancer: impact on postoperative inflammatory and nutritional status. Dis Esophagus. doi:10.1111/dote.12418

Title: The effect of postoperative complications on survival of patients after minimally invasive esophagectomy for esophageal cancer
Authors: Kun-Kun Li
Yin-Jian Wang
Xue-Hai Liu
Qun-You Tan
Yao-Guang Jiang
Wei Guo
Publication date: 01-09-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 9/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5372-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The effect of postoperative complications on survival of patients after minimally invasive esophagectomy for esophageal cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2017

The SmartOR: a distributed sensor network to improve operating room efficiency

Superiority of laparoscopic proximal gastrectomy with hand-sewn esophagogastrostomy over total gastrectomy in improving postoperative body weight loss and quality of life

Does stoma site specimen extraction increase postoperative ileostomy complication rates?

Endoscopic management of post-laparoscopic sleeve gastrectomy stenosis

Endoscopic suture fixation is associated with reduced migration of esophageal fully covered self-expandable metal stents (FCSEMS)

Non-inferiority of minimally invasive oesophagectomy: an 8-year retrospective case series