Major Perioperative Morbidity Does Not Affect Long-Term Survival in Patients Undergoing Esophagectomy for Cancer of the Esophagus or Gastroesophageal Junction

Significant morbidity and mortality have historically been reported for surgical resection of gastric and gastroesophageal junction tumors. We evaluated our experience to determine morbidity and mortality and evaluated demographic and pathologic risk factors associated with postoperative outcome and long-term survival. A retrospective, Institutional Review Board-approved, single-institution database identified 102 patients who underwent resection with curative intent for gastroesophageal junction or gastric carcinoma from 2004 to 2012. The method of Kaplan and Meier was used to describe overall survival and estimate median survival. Of 102 patients, 74 were male and 28 were female. Of these, 24 patients were > 70 years of age at surgery (median = 62.9). Forty esophagectomies, 25 total gastrectomies, and 37 subtotal gastrectomies were performed. Two patients died (one esophagectomy and one gastrectomy). Forty-one developed a complication: 17 minor and 35 major, including six anastomotic leaks. Patients with low preoperative albumin ( P = 0.01) and increased age ( P = 0.05) were associated with having a postoperative complication; extent of nodal dissection ( P = 0.48), jejunostomy (0.24), performance status ( P = 0.77), type of surgery ( P = 0.74), and neoadjuvant therapy ( P = 0.24) were not associated. More extensive nodal dissection was associated with a decreased risk of death ( P = 0.007). Having any complication ( P = 0.20), an anastomotic leak ( P = 0.17), worse grade of complication ( P = 0.15), presence of feeding jejunostomy tube ( P = 0.17), and neoadjuvant therapy ( P = 0.30) were not associated with changes in overall survival. Thorough lymph node dissection improves survival without increasing postoperative morbidity. The data advocate for increased lymph node yield and close attention to nutritional support in gastroesophageal carcinoma patients.

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Su1787 Long-Term Survival Comparing Carcinoma of the Gastroesophageal Junction With Gastric Cancer - Results of the German Gastric Cancer Study 2

Gastroenterology ◽

10.1016/s0016-5085(15)33919-6 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-1149

Author(s):

Ralf Steinert ◽

Ingo Gastinger ◽

Karsten Ridwelski ◽

Henry Ptok ◽

Meyer Frank ◽

...

Keyword(s):

Gastric Cancer ◽

Gastroesophageal Junction ◽

Term Survival ◽

Long Term Survival ◽

Cancer Study ◽

Gastric Cancer Study

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Impact of Smoking Status on Perioperative Morbidity, Mortality, and Long-Term Survival Following Transthoracic Esophagectomy for Esophageal Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-021-09720-6 ◽

2021 ◽

Author(s):

Sivesh K. Kamarajah ◽

Anantha Madhavan ◽

Jakub Chmelo ◽

Maziar Navidi ◽

Shajahan Wahed ◽

...

Keyword(s):

Esophageal Cancer ◽

Smoking Status ◽

Pulmonary Complications ◽

Morbidity And Mortality ◽

Transthoracic Esophagectomy ◽

Anastomotic Leaks ◽

Term Survival ◽

Long Term Survival ◽

Perioperative Morbidity

Abstract Introduction Esophagectomy is a key component in the curative treatment of esophageal cancer. Little is understood about the impact of smoking status on perioperative morbidity and mortality and the long-term outcome of patients following esophagectomy. Objective This study aimed to evaluate morbidity and mortality according to smoking status in patients undergoing esophagectomy for esophageal cancer. Methods Consecutive patients undergoing two-stage transthoracic esophagectomy (TTE) for esophageal cancers (adenocarcinoma or squamous cell carcinoma) between January 1997 and December 2016 at the Northern Oesophagogastric Unit were included from a prospectively maintained database. The main explanatory variable was smoking status, defined as current smoker, ex-smoker, and non-smoker. The primary outcome was overall survival (OS), while secondary outcomes included perioperative complications (overall, anastomotic leaks, and pulmonary complications) and survival (cancer-specific survival [CSS], recurrence-free survival [RFS]). Results During the study period, 1168 patients underwent esophagectomy for cancer. Of these, 24% (n = 282) were current smokers and only 30% (n = 356) had never smoked. The median OS of current smokers was significantly shorter than ex-smokers and non-smokers (median 36 vs. 42 vs. 48 months; p = 0.015). However, on adjusted analysis, there was no significant difference in long-term OS between smoking status in the entire cohort. The overall complication rates were significantly higher with current smokers compared with ex-smokers or non-smokers (73% vs. 66% vs. 62%; p = 0.018), and there were no significant differences in anastomotic leaks and pulmonary complications between the groups. On subgroup analysis by receipt of neoadjuvant therapy and tumor histology, smoking status did not impact long-term survival in adjusted multivariable analyses. Conclusion Although smoking is associated with higher rates of short-term perioperative morbidity, it does not affect long-term OS, CSS, and RFS following esophagectomy for esophageal cancer. Therefore, implementation of perioperative pathways to optimize patients may help reduce the risk of complications.

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