Laura F C Fransen1, Gijs H K Berkelmans1, Emanuele Asti2, Mark I van Berge Henegouwen3, Felix Berlth4, Luigi Bonavina2, Andrew Brown5, Christiane Bruns4, Elke van Daele6, Suzanne S Gisbertz3, Peter P Grimminger7, Christian A Gutschow8, Gerjon Hannink9, Arnulf H Hölscher4, Juha Kauppi10, Sjoerd M Lagarde11, Stuart Mercer12, Johnny Moons13, Philippe Nafteux13, Magnus Nilsson14, Francesco Palazzo5, Piet Pattyn6, Dimitri A Raptis8, Jari Räsanen10, Ernest L Rosato5, Ioannis Rouvelas14, Henner M Schmidt8, Paul M Schneider15, Wolfgang Schröder4, Pieter C van der Sluis7, Bas P L Wijnhoven11, Grard A P Nieuwenhuijzen1, Misha D P Luyer1. 1. Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands. 2. Department of Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy. 3. Department of Surgery, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 4. Department of General, Visceral and Cancer Surgery, University Hospital Cologne, Cologne, Germany. 5. Department of Surgery, Thomas Jefferson University, Philadelphia, PA. 6. Department of Surgery, University Center Ghent, Ghent, Belgium. 7. Department of General-, Visceral-, and Transplant Surgery, University Medical Center Mainz, Mainz, Germany. 8. Center for Visceral, Thoracic and specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland. 9. Department of Operating Rooms and MITeC Technology Center, Radboud University Medical Center, Nijmegen, the Netherlands. 10. Department of General Thoracic and Esophageal Surgery, Helsinki University Hospital, Helsinki, Finland. 11. Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands. 12. Department of Upper GI Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom. 13. Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium. 14. Division of Surgery, CLINTEC, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. 15. Department of General and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland.
Abstract
BACKGROUND: Esophagectomy is a technically challenging procedure, associated with significant morbidity. The introduction of minimally invasive esophagectomy (MIE) has reduced postoperative morbidity. OBJECTIVE: Although the short-term effect on complications is increasingly being recognized, the impact on long-term survival remains unclear. This study aims to investigate the association between postoperative complications following MIE and long-term survival. METHODS: Data were collected from the EsoBenchmark Collaborative composed by 13 high-volume, expert centers routinely performing MIE. Patients operated between June 1, 2011 and May 31, 2016 were included. Complications were graded using the Clavien-Dindo (CD) classification. To correct for short-term effects of postoperative complications on mortality, patients who died within 90 days postoperative were excluded. Primary endpoint was 5-year overall survival. RESULTS: A total of 915 patients were included with a mean follow-up time of 30.8 months (standard deviation 17.9). Complications occurred in 542 patients (59.2%) of which 50.2% had a CD grade ≥III complication [ie, (re)intervention, organ dysfunction, or death]. The incidence of anastomotic leakage (AL) was 135 of 915 patients (14.8%) of which 84 patients were classified as a CD grade ≥III. Multivariable analysis showed a significantly deteriorated long-term survival in all patients with AL [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.25-2.24]. This inverse relation was most distinct when AL was scored as a CD grade ≥III (HR 1.83, 95% CI 1.30-2.58). For all other complications, no significant association with long-term survival was found. CONCLUSION: The occurrence and severity of AL, but not overall complications, after MIE negatively affect long-term survival of esophageal cancer patients.
BACKGROUND: Esophagectomy is a technically challenging procedure, associated with significant morbidity. The introduction of minimally invasive esophagectomy (MIE) has reduced postoperative morbidity. OBJECTIVE: Although the short-term effect on complications is increasingly being recognized, the impact on long-term survival remains unclear. This study aims to investigate the association between postoperative complications following MIE and long-term survival. METHODS: Data were collected from the EsoBenchmark Collaborative composed by 13 high-volume, expert centers routinely performing MIE. Patients operated between June 1, 2011 and May 31, 2016 were included. Complications were graded using the Clavien-Dindo (CD) classification. To correct for short-term effects of postoperative complications on mortality, patients who died within 90 days postoperative were excluded. Primary endpoint was 5-year overall survival. RESULTS: A total of 915 patients were included with a mean follow-up time of 30.8 months (standard deviation 17.9). Complications occurred in 542 patients (59.2%) of which 50.2% had a CD grade ≥III complication [ie, (re)intervention, organ dysfunction, or death]. The incidence of anastomotic leakage (AL) was 135 of 915 patients (14.8%) of which 84 patients were classified as a CD grade ≥III. Multivariable analysis showed a significantly deteriorated long-term survival in all patients with AL [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.25-2.24]. This inverse relation was most distinct when AL was scored as a CD grade ≥III (HR 1.83, 95% CI 1.30-2.58). For all other complications, no significant association with long-term survival was found. CONCLUSION: The occurrence and severity of AL, but not overall complications, after MIE negatively affect long-term survival of esophageal cancer patients.
Authors: Masaru Hayami; Nelson Ndegwa; Mats Lindblad; Gustav Linder; Jakob Hedberg; David Edholm; Jan Johansson; Jesper Lagergren; Lars Lundell; Magnus Nilsson; Ioannis Rouvelas Journal: Ann Surg Oncol Date: 2022-06-25 Impact factor: 4.339