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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 9/2019

Open Access 01-09-2019 | Esophageal Cancer | Thoracic Oncology

Cardiorespiratory Comorbidity and Postoperative Complications following Esophagectomy: a European Multicenter Cohort Study

Authors: F. Klevebro, MD, PhD, J. A. Elliott, MD, PhD, A. Slaman, MD, PhD, B. D. Vermeulen, MD, PhD, S. Kamiya, MD, PhD, C. Rosman, MD, PhD, S. S. Gisbertz, MD, PhD, P. R. Boshier, MD, PhD, J. V. Reynolds, MD, PhD, I. Rouvelas, MD, PhD, G. B. Hanna, MD, PhD, M. I. van Berge Henegouwen, MD, PhD, S. R. Markar, MD, PhD

Published in: Annals of Surgical Oncology | Issue 9/2019

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Abstract

Background

The impact of cardiorespiratory comorbidity on operative outcomes after esophagectomy remains controversial. This study investigated the effect of cardiorespiratory comorbidity on postoperative complications for patients treated for esophageal or gastroesophageal junction cancer.

Patients and Methods

A European multicenter cohort study from five high-volume esophageal cancer centers including patients treated between 2010 and 2017 was conducted. The effect of cardiorespiratory comorbidity and respiratory function upon postoperative outcomes was assessed.

Results

In total 1590 patients from five centers were included; 274 (17.2%) had respiratory comorbidity, and 468 (29.4%) had cardiac comorbidity. Respiratory comorbidity was associated with increased risk of overall postoperative complications, anastomotic leak, pulmonary complications, pneumonia, increased Clavien–Dindo score, and critical care and hospital length of stay. After neoadjuvant chemoradiotherapy, respiratory comorbidity was associated with increased risk of anastomotic leak [odds ratio (OR) 1.83, 95% confidence interval (CI) 1.11–3.04], pneumonia (OR 1.65, 95% CI 1.10–2.47), and any pulmonary complication (OR 1.52, 95% CI 1.04–2.22), an effect which was not observed following neoadjuvant chemotherapy or surgery alone. Cardiac comorbidity was associated with increased risk of cardiovascular and pulmonary complications, respiratory failure, and Clavien–Dindo score ≥ IIIa. Among all patients, forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio > 70% was associated with reduced risk of overall postoperative complications, cardiovascular complications, atrial fibrillation, pulmonary complications, and pneumonia.

Conclusions

The results of this study suggest that cardiorespiratory comorbidity and impaired pulmonary function are associated with increased risk of postoperative complications after esophagectomy performed in high-volume European centers. Given the observed interaction with neoadjuvant approach, these data indicate a potentially modifiable index of perioperative risk.
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Metadata
Title
Cardiorespiratory Comorbidity and Postoperative Complications following Esophagectomy: a European Multicenter Cohort Study
Authors
F. Klevebro, MD, PhD
J. A. Elliott, MD, PhD
A. Slaman, MD, PhD
B. D. Vermeulen, MD, PhD
S. Kamiya, MD, PhD
C. Rosman, MD, PhD
S. S. Gisbertz, MD, PhD
P. R. Boshier, MD, PhD
J. V. Reynolds, MD, PhD
I. Rouvelas, MD, PhD
G. B. Hanna, MD, PhD
M. I. van Berge Henegouwen, MD, PhD
S. R. Markar, MD, PhD
Publication date
01-09-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 9/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07478-6

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