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Meta-Analysis
. 2024 Jun;76(3):757-767.
doi: 10.1007/s13304-024-01761-2. Epub 2024 Feb 6.

Impact of pulmonary complications following esophagectomy on long-term survival: multivariate meta-analysis and restricted mean survival time assessment

Michele Manara  1 , Davide Bona  2 , Luigi Bonavina  3 , Alberto Aiolfi  2 ; OGSA Group for Esophagogastric Surgery
Collaborators, Affiliations
Meta-Analysis

Impact of pulmonary complications following esophagectomy on long-term survival: multivariate meta-analysis and restricted mean survival time assessment

Michele Manara et al. Updates Surg. 2024 Jun.

Abstract

Pulmonary complications (PC) are common after esophagectomy and their impact on long-term survival is not defined yet. The present study aimed to assess the effect of postoperative PCs on long-term survival after esophagectomy for cancer. Systematic review of the literature through February 1, 2023, was performed. The included studies evaluated the effect of PC on long-term survival. Primary outcome was long-term overall survival (OS). Cancer-specific survival (CSS) and disease-free survival (DFS) were secondary outcomes. Restricted mean survival time difference (RMSTD), hazard ratio (HR), and 95% confidence intervals (CI) were used as pooled effect size measures. Eleven studies were included (3423 patients). Overall, 674 (19.7%) patients developed PC. The RMSTD analysis shows that at 60-month follow-up, patients not experiencing PC live an average of 8.5 (95% CI 6.2-10.8; p < 0.001) months longer compared with those with PC. Similarly, patients not experiencing postoperative PC seem to have significantly longer CSS (8 months; 95% CI 3.7-12.3; p < 0.001) and DFS (5.4 months; 95% CI 1.6-9.1; p = 0.005). The time-dependent HRs analysis shows a reduced mortality hazard in patients without PC at 12 (HR 0.6, 95% CI 0.51-0.69), 24 (HR 0.64, 95% CI 0.55-0.73), 36 (HR 0.67, 95% CI 0.55-0.79), and 60 months (HR 0.69, 95% CI 0.51-0.89). This study suggests a moderate clinical impact of PC on long-term OS, CSS, and DFS after esophagectomy. Patients not experiencing PC seem to have a significantly reduced mortality hazard up to 5 years of follow-up.

Keywords: Esophageal cancer; Esophagectomy; Long-term survival; Postoperative complications; Pulmonary complications.

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Conflict of interest statement

Authors declare that they have no conflict of interest. There is no financial interest or sources to report.

Figures

Fig. 1
Fig. 1
The Preferred Reporting Items for Systematic Reviews checklist (PRISMA) diagram
Fig. 2
Fig. 2
Estimated pooled overall survival (Y axis) for patients with pulmonary complication (red line) and without pulmonary complication (black line). Time (X axis) expressed in months. Relative 95% CI in dashed tract. PC Pulmonary Complications; mos months (Color figure online)
Fig. 3
Fig. 3
No pulmonary complication vs. pulmonary complication overtime hazard ratio variations (Y axis). Continued tracts represent the estimated pooled hazards while dotted tracts represent the 95% Confidence Interval (95% CI). Time (X axis) expressed in months
See this image and copyright information in PMC

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