The Impact of Postoperative Complications on Survivals After Esophagectomy for Esophageal Cancer

Abstract

The aim of this study was to assess the impact of postoperative complications after esophagectomy on long-term outcome.The treatment of esophageal cancer has recently been improved; however, esophagectomy with thoracotomy and laparotomy carries considerable postoperative morbidity and mortality. The real impact of postoperative complications on overall survival is still under evaluation.A retrospective analysis was performed on patients with esophageal cancer who underwent esophagectomy with thoracotomy and laparotomy, with R0 or R1 resection between January 1997 and December 2012. Of 402 patients, we analyzed the following parameters 284 patients who could be followed up for over 5 years: stage of disease, neoadjuvant therapies, surgical approaches, surgical complications, postoperative medical complications, and overall and relapse-free survivals using medical records.Of the 284 patients, 64 (22.5%) had pneumonia, 55 (19.4%) had anastomotic leakage, and 45 (15.8%) had recurrent laryngeal nerve paralysis (RLNP). Pneumonia had a significant negative impact on overall survival (P = 0.035); however, anastomotic leakage and RLNP did not affect overall survival. Multivariate analysis revealed that the presence of pneumonia was predictive of poorer overall survival; the multivariate hazard ratio was 1.456 (95% confidence interval 1.020-2.079, P = 0.039).Pneumonia has a negative impact on overall survival after esophagectomy. Strategies to prevent pneumonia after esophagectomy should improve outcomes in this operation.

FIGURE 1

Kaplan–Meier survival curves for patients undergoing esophagectomy. A: Overall survival curves comparing those with and without pneumonia. B: Relapse-free survival curves comparing those with and without pneumonia. C: Overall survival curves comparing those with and without anastomotic leakage. D: Overall survival curves comparing those with and without recurrent laryngeal nerve paralysis. RLNP = recurrent laryngeal nerve paralysis.

FIGURE 2

Subgroup analyses of Kaplan–Meier survival curves for patients with or without pneumonia undergoing esophagectomy. A: Overall survival curves for the patients aged under 64. B: Overall survival curves for the patients aged over 65. C: Relapse-free survival curves for the patients aged over 65. D: Overall survival curves for the patients in cStage I. E: Relapse-free survival curves for the patients in cStage I. F: Overall survival curves for the patients in cStage II/III/IV.