Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Feb;29(2):1358-1373.
doi: 10.1245/s10434-021-10734-3. Epub 2021 Sep 5.

Patient-Related Prognostic Factors for Anastomotic Leakage, Major Complications, and Short-Term Mortality Following Esophagectomy for Cancer: A Systematic Review and Meta-Analyses

Robert T van Kooten  1 , Daan M Voeten  2 , Ewout W Steyerberg  3 , Henk H Hartgrink  4 , Mark I van Berge Henegouwen  2 , Richard van Hillegersberg  5 , Rob A E M Tollenaar  4 , Michel W J M Wouters  3   6
Affiliations
Meta-Analysis

Patient-Related Prognostic Factors for Anastomotic Leakage, Major Complications, and Short-Term Mortality Following Esophagectomy for Cancer: A Systematic Review and Meta-Analyses

Robert T van Kooten et al. Ann Surg Oncol. 2022 Feb.

Abstract

Objective: The aim of this study is to identify preoperative patient-related prognostic factors for anastomotic leakage, mortality, and major complications in patients undergoing oncological esophagectomy.

Background: Esophagectomy is a high-risk procedure with an incidence of major complications around 25% and short-term mortality around 4%.

Methods: We systematically searched the Medline and Embase databases for studies investigating the associations between patient-related prognostic factors and anastomotic leakage, major postoperative complications (Clavien-Dindo ≥ IIIa), and/or 30-day/in-hospital mortality after esophagectomy for cancer.

Results: Thirty-nine eligible studies identifying 37 prognostic factors were included. Cardiac comorbidity was associated with anastomotic leakage, major complications, and mortality. Male sex and diabetes were prognostic factors for anastomotic leakage and major complications. Additionally, American Society of Anesthesiologists (ASA) score > III and renal disease were associated with anastomotic leakage and mortality. Pulmonary comorbidity, vascular comorbidity, hypertension, and adenocarcinoma tumor histology were identified as prognostic factors for anastomotic leakage. Age > 70 years, habitual alcohol usage, and body mass index (BMI) 18.5-25 kg/m2 were associated with increased risk for mortality.

Conclusions: Various patient-related prognostic factors are associated with anastomotic leakage, major postoperative complications, and postoperative mortality following oncological esophagectomy. This knowledge may define case-mix adjustment models used in benchmarking or auditing and may assist in selection of patients eligible for surgery or tailored perioperative care.

PubMed Disclaimer

Conflict of interest statement

M.I.v.B.H. is consultant for Mylan, Johnson & Johnson, Alesi Surgical, and Medtronic, and received research grants from Olympus and Stryker. R.v.H. is consultant for Medtronic and proctoring surgeon for Intuitive Surgical Inc. and trains other surgeons in robot-assisted minimally invasive esophagectomy. For the remaining authors no conflicts of interest were declared.

Figures

Fig. 1.
Fig. 1.
PRISMA flowchart of study selection
See this image and copyright information in PMC

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492. - DOI - PubMed
    1. Ruol A, Castoro C, Portale G, et al. Trends in management and prognosis for esophageal cancer surgery: twenty-five years of experience at a single institution. Arch Surg. 2009;144(3):247–254. - PubMed
    1. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074–2084. - PubMed
    1. Busweiler LA, Henneman D, Dikken JL, et al. Failure-to-rescue in patients undergoing surgery for esophageal or gastric cancer. Eur J Surg Oncol. 2017;43(10):1962–1969. - PubMed
    1. Abdelsattar ZM, Habermann E, Borah BJ, Moriarty JP, Rojas RL, Blackmon SH. Understanding failure to rescue after esophagectomy in the United States. Ann Thorac Surg. 2020;109(3):865–871. - PubMed