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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2011

01-06-2011 | Thoracic Oncology

In-Hospital Mortality After a Surgical Resection for Esophageal Cancer: Analyses of the Associated Factors and Historical Changes

Authors: Masaru Morita, MD, PhD, FACS, Tomonori Nakanoko, MD, Yoshihiko Fujinaka, MD, Nobuhide Kubo, MD, Natsumi Yamashita, MD, Keiji Yoshinaga, MD, PhD, Hiroshi Saeki, MD, PhD, Yasunori Emi, MD, PhD, Yoshihiro Kakeji, MD, PhD, FACS, Ken Shirabe, MD, PhD, FACS, Yoshihiko Maehara, MD, PhD, FACS

Published in: Annals of Surgical Oncology | Issue 6/2011

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Abstract

Background

Resections for esophageal cancer are invasive, with high mortality and morbidity rates. The object of this study was to clarify the factors associated with in-hospital death while also evaluating any associated historical changes in the characteristics of such deaths.

Methods

The factors associated with mortality were examined by logistic regression analysis in 1106 patients who underwent an esophagectomy for esophageal cancer. The historical changes in the characteristics of in-hospital deaths were also evaluated.

Results

A multivariate analysis revealed that not only undergoing an esophagectomy before 1979, but also a patient’s age (odds ratio 1.070 for every increase in age by year) and an incomplete resection (odds ratio 2.265) were independent factors associated with in-hospital death. The in-hospital mortality rates were 16.1%, 5.8%, 2.5%, and 3.1%, while the 30-day mortality rates were 9.2%, 2.2%, 0.8%, and 0.3% during 1964–1979, the 1980s, the 1990s, and the 2000s, respectively. Eight patients had preoperative comorbidities among 11 patients who died in the hospital after 1997. The mortality rate was 5.5% in patients with any comorbidities, while it was 1.3% in patients without any comorbidities (P = 0.026). The most common direct cause of in-hospital death was previous pulmonary complications; however, cancer progression has recently become the most common cause.

Conclusions

To prevent in-hospital mortality after an esophagectomy, strict indications for surgery and careful perioperative management are important, especially in high-risk patients with advanced esophageal cancer.
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Metadata
Title
In-Hospital Mortality After a Surgical Resection for Esophageal Cancer: Analyses of the Associated Factors and Historical Changes
Authors
Masaru Morita, MD, PhD, FACS
Tomonori Nakanoko, MD
Yoshihiko Fujinaka, MD
Nobuhide Kubo, MD
Natsumi Yamashita, MD
Keiji Yoshinaga, MD, PhD
Hiroshi Saeki, MD, PhD
Yasunori Emi, MD, PhD
Yoshihiro Kakeji, MD, PhD, FACS
Ken Shirabe, MD, PhD, FACS
Yoshihiko Maehara, MD, PhD, FACS
Publication date
01-06-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1502-5

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