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Review
. 2018 Apr 19;2(5):276-284.
doi: 10.1002/bjs5.64. eCollection 2018 Sep.

Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer

E Booka  1 , H Takeuchi  1   2 , K Suda  1 , K Fukuda  1 , R Nakamura  1 , N Wada  1 , H Kawakubo  1 , Y Kitagawa  1
Affiliations
Review

Meta-analysis of the impact of postoperative complications on survival after oesophagectomy for cancer

E Booka et al. BJS Open. .

Abstract

Background: Oesophagectomy has a high risk of postoperative morbidity. The impact of postoperative complications on overall survival of oesophageal cancer remains unclear. This meta-analysis addressed the impact of complications on long-term survival following oesophagectomy.

Methods: A search of PubMed and Cochrane Library databases was undertaken for systematic review of papers published between January 1995 and August 2016 that analysed the relation between postoperative complications and long-term survival. In the meta-analysis, data were pooled. The main outcome was overall survival (OS). Secondary endpoints included disease-free (DFS) and cancer-specific (CSS) survival.

Results: A total of 357 citations was reviewed; 21 studies comprising 11 368 patients were included in the analyses. Overall, postoperative complications were associated with significantly decreased 5-year OS (hazard ratio (HR) 1·16, 95 per cent c.i. 1·06 to 1·26; P = 0·001) and 5-year CSS (HR 1·27, 1·09 to 1·47; P = 0·002). Pulmonary complications were associated with decreased 5-year OS (HR 1·37, 1·16 to 1·62; P < 0·001), CSS (HR 1·60, 1·35 to 1·89; P < 0·001) and 5-year DFS (HR 1·16, 1·00 to 1·33; P = 0·05). Patients with anastomotic leakage had significantly decreased 5-year OS (HR 1·20, 1·10 to 1·30; P < 0·001), 5-year CSS (HR 1·81, 1·11 to 2·95; P = 0·02) and 5-year DFS (HR 1·13, 1·02 to 1·25; P = 0·01).

Conclusion: Postoperative complications after oesophagectomy, including pulmonary complications and anastomotic leakage, decreased long-term survival.

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Figures

Figure 1
Figure 1
Flow diagram of inclusion and exclusion criteria for the study
Figure 2
Figure 2
Forest plot comparing overall survival following oesophagectomy in patients with and without a pulmonary complications, b anastomotic leakage and c any complication. Mantel–Haenszel random‐effects (a,c) or fixed‐effect (b) models were used for meta‐analysis. Hazard ratios are shown with 95 per cent confidence intervals
Figure 3
Figure 3
Forest plot comparing cancer‐specific survival following oesophagectomy in patients with and without a pulmonary complications, b anastomotic leakage and c any complication. Mantel–Haenszel fixed‐effect (a,c) or random‐effects (b) models were used for meta‐analysis. Hazard ratios are shown with 95 per cent confidence intervals
Figure 4
Figure 4
Forest plot comparing disease‐free survival following oesophagectomy in patients with and without a pulmonary complications and b anastomotic leakage. A Mantel–Haenszel fixed‐effect model was used for meta‐analysis. Hazard ratios are shown with 95 per cent confidence intervals
See this image and copyright information in PMC

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