Akihiko Okamura1, Kotaro Yamashita1, Ryotaro Kozuki1, Keita Takahashi1, Tasuku Toihata1, Yu Imamura1, Shinji Mine1, Masayuki Watanabe2. 1. Department of Gastroenterological Surgery, Gastroenterology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. 2. Department of Gastroenterological Surgery, Gastroenterology Center, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. masayuki.watanabe@jfcr.or.jp.
Abstract
PURPOSE: Esophagectomy for esophageal cancer is a very invasive surgery that induces an intense systemic inflammatory response. Postoperative infectious complications worsen survival after esophagectomy through inflammatory responses, and this study aimed to investigate the impact of the response on disease recurrence. METHODS: We assessed 230 patients who underwent curative minimally invasive esophagectomy for esophageal squamous cell carcinoma. The area under the curve of serum C-reactive protein levels from preoperative day through postoperative day 7 was defined as the cumulative magnitude of postoperative inflammatory response. RESULTS: Relapse-free survival was compared among quartiles of the area, and fourth quartile showed the worst relapse-free survival. Patients in the fourth quartile were the high group, and others were low group. Compared with low group (n = 173), high group (n = 57) showed significantly worse relapse-free survival and overall survival (P = 0.014 and 0.028, respectively). Multivariate analyses found that high group (P = 0.048) was an independent risk factor for recurrence but not overall survival. Higher body mass index (P < 0.001) and postoperative infections (P < 0.001) were independent risk factors to become high group. However, the influence of high group on recurrence was not affected by postoperative infections in interaction analysis (P = 0.889). CONCLUSIONS: Postoperative intense systemic inflammatory response independently increased the risk of recurrence after curative minimally invasive esophagectomy for esophageal squamous cell carcinoma. Factors associating with intensified inflammatory response are higher body mass index and postoperative infections. Therefore, surgeons should make every effort to prevent postoperative infections to improve the long-term outcomes of patients.
PURPOSE: Esophagectomy for esophageal cancer is a very invasive surgery that induces an intense systemic inflammatory response. Postoperative infectious complications worsen survival after esophagectomy through inflammatory responses, and this study aimed to investigate the impact of the response on disease recurrence. METHODS: We assessed 230 patients who underwent curative minimally invasive esophagectomy for esophageal squamous cell carcinoma. The area under the curve of serum C-reactive protein levels from preoperative day through postoperative day 7 was defined as the cumulative magnitude of postoperative inflammatory response. RESULTS: Relapse-free survival was compared among quartiles of the area, and fourth quartile showed the worst relapse-free survival. Patients in the fourth quartile were the high group, and others were low group. Compared with low group (n = 173), high group (n = 57) showed significantly worse relapse-free survival and overall survival (P = 0.014 and 0.028, respectively). Multivariate analyses found that high group (P = 0.048) was an independent risk factor for recurrence but not overall survival. Higher body mass index (P < 0.001) and postoperative infections (P < 0.001) were independent risk factors to become high group. However, the influence of high group on recurrence was not affected by postoperative infections in interaction analysis (P = 0.889). CONCLUSIONS: Postoperative intense systemic inflammatory response independently increased the risk of recurrence after curative minimally invasive esophagectomy for esophageal squamous cell carcinoma. Factors associating with intensified inflammatory response are higher body mass index and postoperative infections. Therefore, surgeons should make every effort to prevent postoperative infections to improve the long-term outcomes of patients.