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. 2023 Mar 1;277(3):437-441.
doi: 10.1097/SLA.0000000000005093. Epub 2021 Jul 22.

Esophagectomy Complications Impact Long-term Survival: A National Cancer Database Analysis

Sandeep Sachidananda  1 , Lava Timsina  2 , Niharika Namburi  2 , Thomas J Birdas  3
Affiliations

Esophagectomy Complications Impact Long-term Survival: A National Cancer Database Analysis

Sandeep Sachidananda et al. Ann Surg. .

Abstract

Objective: To determine the effect of prolonged length of stay (LOS) after esophagectomy on long term survival.

Background: Complications after esophagectomy have a significant impact in short-term survival. The specific effect of prolonged LOS after esophagectomy is unclear. We hypothesized that postoperative complications that occur after esophagectomy, resulting in prolonged LOS, have a detrimental effect on long term survival.

Methods: All patients undergoing esophagectomy between 2004 and 2014 were identified in the National Cancer Database. To eliminate the confounding effect of short-term mortality, we included only patients who survived at least 90 days postoperatively. Demographics, disease characteristics, and perioperative outcomes were analyzed. Postoperative LOS was used as a surrogate for postoperative complications. The highest quintile of LOS was defined as excessive LOS (ELOS). Kaplan-Meier and Cox proportional hazards survival analyses were performed to examine survival.

Results: A total of 20,719 patients were identified. Of those 3826 had ELOS, with median LOS 26days (range 18-168days). Their median survival was 30.6 months compared to 53.6 months in the entire non-ELOS group (P < 0.0001). After multivariate analysis ELOS (odds ratio 1.56, 95% confidence interval 1.46-1.67) was an independent predictor of overall mortality. Higher disease stage, higher age, male sex, higher Charlson/Deyo comorbidity score, and readmission after discharge were also significant negative predictors of long-term survival, whereas surgery in an academic institution, being at the highest income quartile and having private or Medicare insurance predicted longer survival (all P < 0.001).

Conclusions and relevance: Postoperative complications after esophagectomy, resulting in ELOS, predict lower long-term survival independent of other factors. Counseling patients about surgery should include the detrimental long-term effects of postoperative complications and ELOS. Avoiding ELOS (LOS exceeding 18 days) could be considered a quality metric after esophagectomy.

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Conflict of interest statement

The authors report no conflicts of interest.

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