Effects of Neoadjuvant Chemoradiotherapy on Postoperative Morbidity and Mortality Associated with Esophageal Cancer

Abstract Objective: To determine whether preoperative anthropometric and computed tomography (CT) measurements of body composition can predict postoperative morbidity and mortality in patients with gastric or esophageal cancer. Materials and Methods: This was a retrospective study in which we reviewed the medical records and abdominal CT scans of patients with gastric or esophageal cancer who underwent surgery in 2015 at a cancer center. CT scans performed during routine preoperative evaluation were retrospectively assessed to measure the area of lean body mass at the level of the third lumbar vertebra, as well as the area of visceral and subcutaneous fat. Results: Seventy patients were included in the study. The mean age was 59.9 years (range, 33-82 years), and 47 patients (67.1%) were men. The mean postoperative follow-up period was 14.9 months. Neither postoperative morbidity nor postoperative mortality correlated significantly with gender, age, the type of primary tumor, the presence of comorbidities, smoking status, body mass index, nutritional status, or visceral fat area. The survival rate was higher for patients with normal lean body mass than for those with low lean body mass (hazard ratio = 0.116; 95% confidence interval: 0.015-0.906; p = 0.040). Conclusion: Our data suggest that lean body mass can be a relevant prognostic factor in patients with gastric or esophageal cancer, and that CT measurements should be included in the routine preoperative evaluation, because it may provide information that aids nutritional and clinical care for these patients.

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Association of No Epidural Analgesia with Postoperative Morbidity and Mortality after Transthoracic Esophageal Cancer Resection

Yearbook of Critical Care Medicine ◽

10.1016/s0734-3299(08)70337-x ◽

2007 ◽

Vol 2007 ◽

pp. 183-185

Author(s):

D.J. Dries

Keyword(s):

Esophageal Cancer ◽

Epidural Analgesia ◽

Postoperative Morbidity ◽

Morbidity And Mortality ◽

Cancer Resection

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Outcomes of minimally invasive versus open esophagectomy for esophageal cancer: A single-center case-control study.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.171 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 171-171

Author(s):

Hugo Miguel Teixeira Ferraz Dos Santos Sousa ◽

Márcio Mesquita ◽

Marisa Aral ◽

José Costa-Maia

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Postoperative Morbidity ◽

Case Control Study ◽

Case Control ◽

Morbidity And Mortality ◽

Initial Population ◽

Invasive Approach ◽

Open Esophagectomy ◽

Control Study

171 Background: Esophagectomy is a major surgery associated with significant morbidity and mortality. There is growing evidence in literature that the minimally invasive approach in esophagectomy (MIE) may decrease morbidity. The aim of this study was the comparative analysis of the outcomes between MIE and open esophagectomy (OE) for esophageal cancer. Methods: Analysis (case-control study) of a prospective database with esophageal cancer cases submitted to curative intent surgery, between May 2006 and October 2014, in an Upper GI Surgery Unit. For this analysis, cases of non-resectional surgery were excluded. Results: From the initial population (n = 79), 65 cases (Group A: 24 MIE - 13 totally MIE and 11 hybrid MIE; Group B: 41 OE, including 5 cases of conversion from MIE) were included. Both groups were matched for gender, age, comorbidities, BMI, tumor location and histology, staging (cT and cN), neoadjuvant therapy and type of surgery. The presence of postoperative morbidity was 37,5% in MIE vs 61% in OE (p = 0,058), with a rate of respiratory complications of 16,7% and 22%, respectively (p = ns). Statistically significant differences were seen in Clavien classification of postoperative morbidity (p = 0,018) and in postoperative mortality (MIE 0% vs OE 22%, p = 0,021). Conclusions: The results of this case-control study provide further evidence for the feasibility and possible improvements in the postoperative morbidity and mortality of MIE, when performed in differentiated centers.

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TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY 3D HD FOR THORACIC ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY

Journal of Surgical Sciences ◽

10.33695/jss.v5i3.226 ◽

2018 ◽

Vol 5 (3) ◽

pp. 133-146

Author(s):

F. Achim ◽

M. Gheorghe ◽

A. Constantin ◽

P. Hoara ◽

C. Popa ◽

...

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Neoadjuvant Chemoradiotherapy ◽

Advanced Technology ◽

Morbidity And Mortality ◽

Esophageal Reconstruction ◽

Thoracic Esophageal Cancer ◽

Invasive Esophagectomy

Esophagectomy is a major surgical procedure with morbidity, and mortality related to the patient'scondition, stage of the disease at the moment of diagnosis, complementary treatments and surgicalexperience of the surgeon. Minimally invasive esophagectomy (MIE) may lead to a reduction inperioperative morbidity and mortality with an acceptable quality of life and similar oncologic resultsto an open approach. We present an experience of the Center of Excellence in Esophageal Surgeryregarding totally MIE through thoracolaparoscopic modified McKeown triple approach, followedby esophageal reconstruction by gastric intrathoracic pull-up and cervical esophagogastricanastomosis and feeding jejunostomy in a patient with thoracic esophageal cancer who underwentpreoperative neoadjuvant chemoradiotherapy. The short-term outcomes of the totally minimallyinvasive esophagectomy procedure were very encouraging. The overall operative times were:thoracoscopic - 120 minutes, laparoscopic - 130 minutes and cervical - 50 minutes with a total of360 minutes. The intraoperative blood loss was 200 ml. The postoperative outcome was favorablewith early feeding on the jejunostomy. The control of cervical anastomosis was performed in the 6thday postoperative and the patient was discharged in the 10th day postoperative without anysymptomatology. At the first and third-month follow-up was not reported any postoperativecomplications. The totally minimally invasive approach using advanced technology of endoscopicsurgery allowed for this patient a simple postoperative evolution, no major complications and agood recovery after extensive surgery. The solid experience in open esophageal surgery ofUpper Gastro-Intestinal surgeons provides a fast learning curve of complex minimally invasivesurgical procedures with reduced perioperative morbidity. Long-term follow-up can confirm theresults from the literature regarding the survival, which is expected to be for these patients atleast equivalent with outcomes after open esophagectomy.

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Association of No Epidural Analgesia with Postoperative Morbidity and Mortality after Transthoracic Esophageal Cancer Resection

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2005.11.023 ◽

2006 ◽

Vol 202 (3) ◽

pp. 395-400 ◽

Cited By ~ 69

Author(s):

Huibert A. Cense ◽

Sjoerd M. Lagarde ◽

Koen de Jong ◽

Jikke M.T. Omloo ◽

Olivier R.C. Busch ◽

...

Keyword(s):

Esophageal Cancer ◽

Epidural Analgesia ◽

Postoperative Morbidity ◽

Morbidity And Mortality ◽

Cancer Resection

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Surgical Outcome of Colon Interposition in Esophageal Cancer Surgery: Analysis of Risk Factors for Conduit-Related Morbidity

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1606828 ◽

2017 ◽

Vol 66 (05) ◽

pp. 384-389 ◽

Cited By ~ 3

Author(s):

Kanghoon Lee ◽

Seung-Il Park ◽

Dong Kim ◽

Yong-Hee Kim ◽

Se Choi ◽

...

Keyword(s):

Esophageal Cancer ◽

Graft Failure ◽

Postoperative Morbidity ◽

Neoadjuvant Chemoradiotherapy ◽

Significant Risk ◽

Pulmonary Complications ◽

Colon Interposition ◽

Esophageal Reconstruction ◽

Survival Duration ◽

Complication Rates

Background We aimed to assess the feasibility, surgical outcomes, and conduit-related complications of colon interposition in patients with esophageal cancer. Methods Patients with esophageal cancer who underwent colon interposition for esophageal reconstruction between June 2000 and June 2013 were retrospectively reviewed. Results A total of 67 consecutive patients (mean age, 62.2 ± 7.9 years) were enrolled. During this time period, 944 patients underwent esophageal reconstruction using gastric conduit. Twelve patients (17.9%) also received neoadjuvant chemoradiotherapy (nCRT). The median follow-up duration was 44 months (range, 1–168 months); median survival duration was 63 months (range, 1–168 months); and 3- and 5-year overall survival rates were 61.6 and 49.4%, respectively. A total of 43 patients (64.2%) experienced at least 1 postoperative morbidity. According to the Clavien–Dindo grading system, 36 patients (54%) experienced postoperative morbidity of higher than Grade III. Pulmonary complications were most commonly observed complications among the patients (18 patients, 26.9%). Anastomosis site leakage developed in 11 patients (16.4%), and 3 of these patients (6.0%) eventually experienced graft failure. On multivariate analysis, nCRT was determined as a significant risk factor for conduit-related complications (leakage, graft failure, fistula, and stricture). Conclusion Colon interposition is associated with relatively high complication rates, whereas nCRT is associated with conduit morbidity.

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Association of No Epidural Analgesia with Postoperative Morbidity and Mortality after Transthoracic Esophageal Cancer Resection

Yearbook of Anesthesiology and Pain Management ◽

10.1016/s1073-5437(08)70190-6 ◽

2007 ◽

Vol 2007 ◽

pp. 215-216

Author(s):

S.E. Abram

Keyword(s):

Esophageal Cancer ◽

Epidural Analgesia ◽

Postoperative Morbidity ◽

Morbidity And Mortality ◽

Cancer Resection

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The Influence of Pretherapeutic and Preoperative Sarcopenia on Short-Term Outcome after Esophagectomy

Cancers ◽

10.3390/cancers12113409 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3409

Author(s):

Johanna Grün ◽

Lea Elfinger ◽

Han Le ◽

Christel Weiß ◽

Mirko Otto ◽

...

Keyword(s):

Esophageal Cancer ◽

Nutritional Status ◽

Cancer Patients ◽

Postoperative Morbidity ◽

Neoadjuvant Treatment ◽

Postoperative Outcome ◽

Morbidity And Mortality ◽

Short Term ◽

Term Outcome ◽

Skeletal Muscle Index

By introducing minimally invasive surgery the rate of postoperative morbidity in esophageal cancer patients could be reduced. But esophagectomy is still associated with a relevant risk of postoperative morbidity and mortality. Patients often present with nutritional deficiency and sarcopenia even at time of diagnosis. This study focuses on the influence of skeletal muscle index (SMI) on postoperative morbidity and mortality. Fifty-two patients were included in this study. SMI was measured using computer tomographic images at the time of diagnosis and before surgery. Then, SMI and different clinicopathological and demographic features were correlated with postoperative morbidity. There was no correlation between SMI before neoadjuvant therapy (p = 0.5365) nor before surgery (p = 0.3530) with the short-term postoperative outcome. Regarding cholesterol level before surgery there was a trend for a higher risk of complications with lower cholesterol levels (p = 0.0846). Our findings suggest that a low preoperative SMI does not necessarily predict a poor postoperative outcome in esophageal cancer patients after esophagectomy but that there are many factors that influence the nutritional status of cancer patients. To improve nutritional status, cancer patients at our clinic receive specialized nutritional counselling during neoadjuvant treatment as well as after surgery.

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