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Multicenter Study
. 2021 Dec 1;274(6):e1129-e1137.
doi: 10.1097/SLA.0000000000003772.

The Effect of Postoperative Complications After Minimally Invasive Esophagectomy on Long-term Survival: An International Multicenter Cohort Study

Laura F C Fransen  1 , Gijs H K Berkelmans  1 , Emanuele Asti  2 , Mark I van Berge Henegouwen  3 , Felix Berlth  4 , Luigi Bonavina  2 , Andrew Brown  5 , Christiane Bruns  4 , Elke van Daele  6 , Suzanne S Gisbertz  3 , Peter P Grimminger  7 , Christian A Gutschow  8 , Gerjon Hannink  9 , Arnulf H Hölscher  4 , Juha Kauppi  10 , Sjoerd M Lagarde  11 , Stuart Mercer  12 , Johnny Moons  13 , Philippe Nafteux  13 , Magnus Nilsson  14 , Francesco Palazzo  5 , Piet Pattyn  6 , Dimitri A Raptis  8 , Jari Räsanen  10 , Ernest L Rosato  5 , Ioannis Rouvelas  14 , Henner M Schmidt  8 , Paul M Schneider  15 , Wolfgang Schröder  4 , Pieter C van der Sluis  7 , Bas P L Wijnhoven  11 , Grard A P Nieuwenhuijzen  1 , Misha D P Luyer  1 ; EsoBenchmark Collaborative
Affiliations
Multicenter Study

The Effect of Postoperative Complications After Minimally Invasive Esophagectomy on Long-term Survival: An International Multicenter Cohort Study

Laura F C Fransen et al. Ann Surg. .

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.

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Conflict of interest statement

The authors report no conflicts of interest.

Comment in

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