OBJECTIVES: To assess the impact of postoperative complications after transthoracic esophagectomy, using the modified Clavien classification, on recurrence and on its timing in patients with cancer of the esophagus or gastroesophageal junction. BACKGROUND DATA: It is hypothesized that complications after esophagectomy for cancer may have a negative effect on recurrence and its timing because of negative interference with the immune system. METHODS: Out of 150 consecutive patients operated with curative intent between January 2005 and May 2006, the data of 138 patients with macroscopically complete resection and no synchronous other malignancy were graded according to the modified Clavien classification. Uni- and multivariable analyses were performed to study the impact of postoperative complications on tumor recurrence and its timing. RESULTS: Mean age was 63.1 years, male-female ratio was 4:1; 76.1% of the patients underwent primary surgery, 23.9% received induction therapy, R0-resection rate was 92.8%. Adenocarcinoma was found in 75%. Complication rates according to the modified Clavien classification were grade 0: 29.7%, grade 2: 35.5%, grade 3: 17.4%, grade 4: 15.9%, and grade 5 (postoperative mortality): 1.4%. Ten patients developed recurrence within 6 months, 29 within 12 months, 39 within 18 months, 42 within 24 months, totaling up to 47 at 3 years. Univariable analysis retained complications, LN-status, number of positive nodes, extracapsular lymph node involvement (EC LNI), pStage, pT, and R1-status as factors significantly influencing occurrence of recurrence. In the multivariable model, presence of complications, EC LNI, and R1-status were independent negative factors. Cox-regression analysis also identified these same 3 factors as significant determinators for the timing of recurrence. CONCLUSIONS: This study indicates a correlation between complications and early recurrence and its timing. Modified Clavien classification, beside R1-status and EC LNI, appears to be a useful prognostic indicator of early recurrence and its timing. Achieving esophagectomy without postoperative complications is of utmost importance also for oncologic reasons given its negative potential on early oncologic outcome.
OBJECTIVES: To assess the impact of postoperative complications after transthoracic esophagectomy, using the modified Clavien classification, on recurrence and on its timing in patients with cancer of the esophagus or gastroesophageal junction. BACKGROUND DATA: It is hypothesized that complications after esophagectomy for cancer may have a negative effect on recurrence and its timing because of negative interference with the immune system. METHODS: Out of 150 consecutive patients operated with curative intent between January 2005 and May 2006, the data of 138 patients with macroscopically complete resection and no synchronous other malignancy were graded according to the modified Clavien classification. Uni- and multivariable analyses were performed to study the impact of postoperative complications on tumor recurrence and its timing. RESULTS: Mean age was 63.1 years, male-female ratio was 4:1; 76.1% of the patients underwent primary surgery, 23.9% received induction therapy, R0-resection rate was 92.8%. Adenocarcinoma was found in 75%. Complication rates according to the modified Clavien classification were grade 0: 29.7%, grade 2: 35.5%, grade 3: 17.4%, grade 4: 15.9%, and grade 5 (postoperative mortality): 1.4%. Ten patients developed recurrence within 6 months, 29 within 12 months, 39 within 18 months, 42 within 24 months, totaling up to 47 at 3 years. Univariable analysis retained complications, LN-status, number of positive nodes, extracapsular lymph node involvement (EC LNI), pStage, pT, and R1-status as factors significantly influencing occurrence of recurrence. In the multivariable model, presence of complications, EC LNI, and R1-status were independent negative factors. Cox-regression analysis also identified these same 3 factors as significant determinators for the timing of recurrence. CONCLUSIONS: This study indicates a correlation between complications and early recurrence and its timing. Modified Clavien classification, beside R1-status and EC LNI, appears to be a useful prognostic indicator of early recurrence and its timing. Achieving esophagectomy without postoperative complications is of utmost importance also for oncologic reasons given its negative potential on early oncologic outcome.
Authors: Andreas Andreou; Luca Viganò; Giuseppe Zimmitti; Daniel Seehofer; Martin Dreyer; Andreas Pascher; Marcus Bahra; Wenzel Schoening; Volker Schmitz; Peter C Thuss-Patience; Timm Denecke; Gero Puhl; Jean-Nicolas Vauthey; Peter Neuhaus; Lorenzo Capussotti; Johann Pratschke; Sven-Christian Schmidt Journal: J Gastrointest Surg Date: 2014-08-27 Impact factor: 3.452
Authors: Vernissia Tam; James D Luketich; Daniel G Winger; Inderpal S Sarkaria; Ryan M Levy; Neil A Christie; Omar Awais; Manisha R Shende; Katie S Nason Journal: Ann Thorac Surg Date: 2016-06-25 Impact factor: 4.330
Authors: Wenchuan Wu; Jin He; John L Cameron; Martin Makary; Kevin Soares; Nita Ahuja; Neda Rezaee; Joseph Herman; Lei Zheng; Daniel Laheru; Michael A Choti; Ralph H Hruban; Timothy M Pawlik; Christopher L Wolfgang; Matthew J Weiss Journal: Ann Surg Oncol Date: 2014-04-26 Impact factor: 5.344
Authors: Sam C Wang; Joanne F Chou; Vivian E Strong; Murray F Brennan; Marinela Capanu; Daniel G Coit Journal: Ann Surg Date: 2016-02 Impact factor: 12.969