학술논문
Impact of postoperative complications on survival after oesophagectomy for oesophageal cancer
Original article
Original article
Document Type
Theater review
Source
BJS Open. June 2020, Vol. 4 Issue 3, p405, 11 p.
Subject
Language
English
Abstract
Introduction Despite advances in treatment, oesophageal cancer remains the sixth most common cause of cancer-related mortality worldwide, with an increasing incidence in the West (1,2). The mainstay of curative therapy [...]
Background: Recent evidence suggests that complications after oesophagectomy may decrease short-and long-term survival of patients with oesophageal cancer. This study aimed to analyse the impact of complications on survival in a Western cohort. Methods: Complications after oesophagectomy were recorded for all patients operated on between January 2006 and February 2017, with severity defined using the Clavien-Dindo classification. Associations between complications and overall and recurrence-free survival were assessed using univariable and multivariable Cox regression models. Results: Of 430 patients, 292 (67.9 per cent) developed postoperative complications, with 128 (39.8 per cent) classified as Clavien-Dindo grade III or IV. No significant associations were detected between Clavien-Dindo grade and either tumour (T) (P = 0.071) or nodal (N) status (P = 0.882). There was a significant correlation between Clavien-Dindo grade and ASA fitness grade (P = 0.032). In multivariable analysis, overall survival in patients with Clavien-Dindo grade I complications was similar to that in patients with no complications (hazard ratio (HR) 0.97, P = 0.915). However, patients with grade II and IV complications had significantly shorter overall survival than those with no complications: HR 1.64 (P = 0.007) and 1.74 (P = 0.013) respectively. Conclusion: Increasing severity of complications after oesophagectomy was associated with decreased overall survival. Prevention of complications should improve survival.
Background: Recent evidence suggests that complications after oesophagectomy may decrease short-and long-term survival of patients with oesophageal cancer. This study aimed to analyse the impact of complications on survival in a Western cohort. Methods: Complications after oesophagectomy were recorded for all patients operated on between January 2006 and February 2017, with severity defined using the Clavien-Dindo classification. Associations between complications and overall and recurrence-free survival were assessed using univariable and multivariable Cox regression models. Results: Of 430 patients, 292 (67.9 per cent) developed postoperative complications, with 128 (39.8 per cent) classified as Clavien-Dindo grade III or IV. No significant associations were detected between Clavien-Dindo grade and either tumour (T) (P = 0.071) or nodal (N) status (P = 0.882). There was a significant correlation between Clavien-Dindo grade and ASA fitness grade (P = 0.032). In multivariable analysis, overall survival in patients with Clavien-Dindo grade I complications was similar to that in patients with no complications (hazard ratio (HR) 0.97, P = 0.915). However, patients with grade II and IV complications had significantly shorter overall survival than those with no complications: HR 1.64 (P = 0.007) and 1.74 (P = 0.013) respectively. Conclusion: Increasing severity of complications after oesophagectomy was associated with decreased overall survival. Prevention of complications should improve survival.