Guillaume Luc1, Marlène Durand, Laurence Chiche, Denis Collet. 1. Department of Digestive Surgery, University Hospital of Bordeaux, Maison du Haut-Lévêque, Avenue de Magellan, 33000, Bordeaux, France, guillaume.luc33@yahoo.fr.
Abstract
BACKGROUND: Esophagectomy provides the best opportunity for a long-term cure despite its high post-operative morbidity. We reviewed our institutional records to evaluate the impact of major post-operative complications on the long-term survival of patients following esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma. METHODS: We identified 241 patients who underwent esophagectomy as a curative procedure at our tertiary referral center. All consecutive patients with locally advanced adenocarcinoma of the esophagus who underwent neoadjuvant treatment followed by esophagectomy were analyzed. Complications were graded according to the Clavien scale. Patients were compared according to the complication grade (grades 0-1-2 vs. grades 3-4). Overall survival and disease-free survival were calculated using the Kaplan-Meier method, and survival curves were compared using log-rank tests. Factors predictive of survival were determined using multivariate analysis. RESULTS: A total of 116 patients underwent esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma of the esophagus. Fifty-four patients (46.5 %) developed post-operative complications. The post-operative mortality rate was 4.3 % (five patients). Patients with grade 3-4 complications had decreased overall survival and disease-free survival rates (p = 0.006 and 0.045). Grade 3-4 complications and positive nodes were found to be contributing factors to survival (p = 0.027 and 0.005). CONCLUSIONS: Our single-institution study found that major morbidity had a negative impact on long-term survival in patients who underwent esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma.
BACKGROUND: Esophagectomy provides the best opportunity for a long-term cure despite its high post-operative morbidity. We reviewed our institutional records to evaluate the impact of major post-operative complications on the long-term survival of patients following esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma. METHODS: We identified 241 patients who underwent esophagectomy as a curative procedure at our tertiary referral center. All consecutive patients with locally advanced adenocarcinoma of the esophagus who underwent neoadjuvant treatment followed by esophagectomy were analyzed. Complications were graded according to the Clavien scale. Patients were compared according to the complication grade (grades 0-1-2 vs. grades 3-4). Overall survival and disease-free survival were calculated using the Kaplan-Meier method, and survival curves were compared using log-rank tests. Factors predictive of survival were determined using multivariate analysis. RESULTS: A total of 116 patients underwent esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma of the esophagus. Fifty-four patients (46.5 %) developed post-operative complications. The post-operative mortality rate was 4.3 % (five patients). Patients with grade 3-4 complications had decreased overall survival and disease-free survival rates (p = 0.006 and 0.045). Grade 3-4 complications and positive nodes were found to be contributing factors to survival (p = 0.027 and 0.005). CONCLUSIONS: Our single-institution study found that major morbidity had a negative impact on long-term survival in patients who underwent esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma.
Authors: S G Swisher; L Deford; K W Merriman; G L Walsh; R Smythe; A Vaporicyan; J A Ajani; T Brown; R Komaki; J A Roth; J B Putnam Journal: J Thorac Cardiovasc Surg Date: 2000-06 Impact factor: 5.209
Authors: J M Wang; O Chertov; P Proost; J J Li; P Menton; L Xu; S Sozzani; A Mantovani; W Gong; V Schirrmacher; J Van Damme; J J Oppenheim Journal: Int J Cancer Date: 1998-03-16 Impact factor: 7.396
Authors: A Zanoni; G Verlato; S Giacopuzzi; J Weindelmayer; F Casella; F Pasini; E Zhao; G de Manzoni Journal: Ann Surg Oncol Date: 2012-12-29 Impact factor: 5.344
Authors: Christos Alexiou; Omar A Khan; Edward Black; Mark L Field; Patrick Onyeaka; Lynda Beggs; John P Duffy; David F Beggs Journal: Ann Thorac Surg Date: 2006-09 Impact factor: 4.330
Authors: Jan B F Hulscher; Johanna W van Sandick; Angela G E M de Boer; Bas P L Wijnhoven; Jan G P Tijssen; Paul Fockens; Peep F M Stalmeier; Fiebo J W ten Kate; Herman van Dekken; Huug Obertop; Hugo W Tilanus; J Jan B van Lanschot Journal: N Engl J Med Date: 2002-11-21 Impact factor: 91.245
Authors: Toni Lerut; Johnny Moons; Willy Coosemans; Dirk Van Raemdonck; Paul De Leyn; Herbert Decaluwé; Georges Decker; Philippe Nafteux Journal: Ann Surg Date: 2009-11 Impact factor: 12.969
Authors: Nabil P Rizk; Peter B Bach; Deborah Schrag; Manjit S Bains; Alan D Turnbull; Martin Karpeh; Murray F Brennan; Valerie W Rusch Journal: J Am Coll Surg Date: 2004-01 Impact factor: 6.113
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