scholarly journals FA01.02: THE EFFECT OF POSTOPERATIVE COMPLICATIONS AFTER MIE ON LONG-TERM SURVIVAL: A RETROSPECTIVE, MULTI-CENTER COHORT STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 1-1 ◽  
Author(s):  
Laura Fransen ◽  
Gijs Berkelmans ◽  
Emanuele Asti ◽  
Mark Van Berge Henegouwen ◽  
Felix Berlth ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Anastomotic Leakage ◽  
Postoperative Morbidity ◽  
Cardiac Complications ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival ◽  
Grade 3

Abstract Background Esophagectomy has a high incidence of postoperative morbidity. Complications lead to a decreased short-term survival, however the influence of those complications on long-term survival is still unclear. Most of the performed studies are small, single center cohort series with inconclusive or conflicting results. Minimally invasive esophagectomy (MIE) has been shown to be associated with a reduced postoperative morbidity. In this study, the influence of complications on long-term survival for patients with esophageal cancer undergoing a MIE were investigated. Methods Data was collected from the EsoBenchmark database, a collaboration of 13 high-volume centers routinely performing MIE. Patients were included in this database from June 1, 2011 until May 31, 2016. Complications were scored according to the Clavien-Dindo (CD) classification for surgical complications. Major complications were defined as a CD grade ≥ 3. The data were corrected for 90-day mortality to correct for the short-term effect of postoperative complications on mortality. Overall survival was analyzed using the Kaplan Meier, log rank- and (uni- and multivariable) Cox-regression analyses. Results A total of 926 patients were eligible for analysis. Mean follow-up time was 30.8 months (SD 17.9). Complications occurred in 543 patients (59.2%) of which 39.3% had a major complication. Anastomotic leakage (AL) occurred in 135 patients (14.5%) of which 9.2% needed an intervention (CD grade ≥ 3). A significant worse long-term survival was observed in patients with any AL (HR 1.73, 95% CI 1.29–2.32, P < 0.001) and for patients with AL CD grade ≥3 (HR 1.86, 95% CI 1.32–2.63, P < 0.001). Major cardiac complications occurred in 18 patients (1.9%) and were related to a decreased long-term survival (HR 2.72, 95% CI 1.38–5.35, p 0.004). For all other complications, no significant influence on long-term survival was found. Conclusion The occurrence and severity of anastomotic leakage and cardiac complications after MIE negatively affect long-term survival of esophageal cancer patients. Disclosure All authors have declared no conflicts of interest.

scholarly journals Patient Age and Survival After Surgery for Esophageal Cancer

2020 ◽  
Vol 28 (1) ◽  
pp. 159-166 ◽  
Author(s):  
Jesper Lagergren ◽  
Matteo Bottai ◽  
Giola Santoni
Keyword(s):  
Esophageal Cancer ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival ◽  
Flexible Parametric Model ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Disease Specific Mortality ◽  
Disease Specific

Abstract Background Esophagectomy for esophageal cancer is associated with a substantial risk of life-threatening complications and a limited long-term survival. This study aimed to clarify the controversial questions of how age influences short-term and long-term survival. Methods This population-based cohort study included almost all patients who underwent curatively intended esophagectomy for esophageal cancer in Sweden in 1987–2010, with follow-up through 2016. The exposure was age, analyzed both as a continuous and categorical variable. The probability of mortality was computed using a novel flexible parametric model approach. The reported probabilities are proper measures of the risk of dying, and the related odds ratios (OR) are therefore more suitable measures of association than hazard ratios. The outcomes were 90-day all-cause mortality, 5-year all-cause mortality, and 5-year disease-specific mortality. A novel flexible parametric model was used to derive the instantaneous probability of dying and the related OR along with 95% confidence intervals (CIs), adjusted for sex, education, comorbidity, tumor histology, pathological tumor stage, and resection margin status. Results Among 1737 included patients, the median age was 65.6 years. When analyzed as a continuous variable, older age was associated with slightly higher odds of 90-day all-cause mortality (OR 1.05, 95% CI 1.02–1.07), 5-year all-cause mortality (OR 1.02, 95% CI 1.01–1.03), and 5-year disease-specific mortality (OR 1.01, 95% CI 1.01–1.02). Compared with patients aged < 70 years, those aged 70–74 years had no increased risk of any mortality outcome, while patients aged ≥ 75 years had higher odds of 90-day mortality (OR 2.85, 95% CI 1.68–4.84), 5-year all-cause mortality (OR 1.56, 95% CI 1.27–1.92), and 5-year disease-specific mortality (OR 1.38, 95% CI 1.09–1.76). Conclusions Patient age 75 years or older at esophagectomy for esophageal cancer appears to be an independent risk factor for higher short-term mortality and lower long-term survival.

scholarly journals CXCR2 expression and postoperative complications affect long-term survival in patients with esophageal cancer

2015 ◽  
Vol 13 (1) ◽  
Author(s):  
Tomohiko Nishi ◽  
Hiroya Takeuchi ◽  
Sachiko Matsuda ◽  
Masaharu Ogura ◽  
Hirofumi Kawakubo ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Term Survival ◽  
Long Term Survival ◽  
Cxcr2 Expression

697 ESOPHAGECTOMY ANASTOMOTIC LEAKS DECREASE LONG TERM SURVIVAL AFTER SURGERY FOR ESOPHAGEAL CANCER: MOVING FROM RESCUE TO PREVENTION.

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Catherine Cheang ◽  
Pradeep Patil
Keyword(s):  
Esophageal Cancer ◽  
Survival Rates ◽  
Standard Of Care ◽  
Innovative Technology ◽  
Anastomotic Leaks ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival ◽  
The Difference

Abstract   Multimodal therapy including esophagectomy is the standard of care for esophageal cancer with a view to achieve long-term survival. Leaks from esophageal anastomoses are associated with major short-term morbidity and mortality. The aim of this study was to analyse our anastomotic leaks following esophagectomy for cancer, their effect on short-term mortality and any effect on long term survival. Methods All patients undergoing esophagectomy for esophageal cancer over 10 years from 2011 to 2020 in our centre were selected for this study from a prospectively maintained database. Patients with leaks were identified by reviewing their case records, electronic records, endoscopy and radiological results. All leaks including non-clinical radiological leaks were included in the study. Overall survival was calculated from date of surgery to death or otherwise censored. Statistical analysis was carried out using SPSS. Results 104 consecutive patients were identified of whom 10 patients (9.6%) had anastomotic leaks. 8 of these patients (80%) were rescued and were well enough to be discharged home. The median survival of patients with leaks was 11.6 months compared to 52.9 months for patients without leaks. The 3-year survival was 30% in patients with leaks compared to 59.9% (p = 0.23, Fisher’s exact) in patients without leaks. The Kaplan Meier survival analysis curves are shown here and the difference in survival was very close to being statistically significant with p = 0.089 (Log Rank) and p = 0.056 (Breslow). Conclusion Esophageal anastomotic leak rates are still exceedingly high at 10%. The rescue rate of 80% is significantly better compared to previous decades. Despite the high rescue rate, these patients have extremely poor long-term survival rates. The future should aim for innovative technology and strategies to eliminate esophageal anastomotic leaks for optimal short- and long-term outcomes.

P59 PREDICTORS FOR ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY AND IMPACT ON SURVIVAL

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R C. Hagens Eliza ◽  
A Reijntjes BSc Maud ◽  
M C J Anderegg ◽  
S Gisbertz Suzanne ◽  
Mark I van Berge Henegouwen
Keyword(s):  
Diabetes Mellitus ◽  
Anastomotic Leakage ◽  
Cox Regression ◽  
Gastroesophageal Junction ◽  
Radical Resection ◽  
Term Survival ◽  
Long Term Survival ◽  
Impact On Survival ◽  
Grade 3

Abstract Aim To identify predictors for anastomotic leakage after esophagectomy and to determine the influence of anastomotic leakage on short-term and long-term survival. Background and methods Identifying predictors of anastomotic leakage after esophagectomy may contribute to its prevention. The influence of anastomotic leakage on long-term survival is unclear. A retrospective cohort study was conducted in consecutive patients who underwent an esophagectomy with reconstruction in the Amsterdam UMC, location AMC, between January 1993 and January 2019. Logistic regression and Cox regression models were used to assess predictors for anastomotic leakage and to assess survival. Results 1747 patients were included, of which 326 (18.7%) developed anastomotic leakage. Independent predictors of cervical anastomotic leakage were diabetes mellitus, cT4-stage and a gastroesophageal junction tumor. ASA grade 3-5, a non-radical resection, pT2-stage, pN+ and hand sewn anastomosis were independent predictors of intrathoracic anastomotic leakage (table 1). 30-day mortality was 2% in patients without, and 4% of patients with anastomotic leakage (p=0.076). Anastomotic leakage did not significantly influence long-term survival when corrected for confounders (HR 0.96 95%CI 0.81 – 1.14, p=0.618). Conclusion Independent risk factors for anastomotic leakage after esophagectomy are diabetes mellitus, cT4-stage and a gastroesophageal junction tumor for cervical anastomosis, and ASA grade 3-5, a non-radical resection, pT2-stage, pN+ and hand sewn anastomosis for intrathoracic anastomosis. 30-day mortality was higher in the anastomotic leakage group. We found no correlation between anastomotic leakage and long term survival.

Tu1772 The Influence of Postoperative Complications on Recurrence and Long-Term Survival After Esophagectomy for Esophageal Cancer

2012 ◽  
Vol 142 (5) ◽  
pp. S-1095
Author(s):  
Arzu Oezcelik ◽  
Shahin Ayazi ◽  
Steven R. DeMeester ◽  
Joerg Zehetner ◽  
Jeffrey A. Hagen ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Postoperative Complications ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Major postoperative complications increase tumor recurrence rate and diminish long-term survival following resection for pancreatic ductal adenocarcinoma

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
A Andreou ◽  
P Aeschbacher ◽  
A S Wenning ◽  
D Candinas ◽  
B Gloor
Keyword(s):  
Postoperative Complications ◽  
Confidence Interval ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Tumor Recurrence ◽  
Postoperative Morbidity ◽  
Hazard Ratio ◽  
Ductal Adenocarcinoma ◽  
Term Survival ◽  
Long Term Survival

Abstract Objective Major complications have been associated with worse oncologic outcomes following resection for several gastrointestinal malignancies. However, the impact of major postoperative morbidity on the survival of patients undergoing resection for pancreatic ductal adenocarcinoma (PDAC) remains unclear. Methods Clinicopathological data of patients who underwent resection for PDAC between 2014 and 2019 in a major swiss hepatopancreatobiliary center were assessed. We evaluated the disease-free (DFS) and overall survival (OS) of patients suffering a major postoperative complication (grade-3 or higher within 90 days according to Clavien-Dindo classification) in comparison to those of patients without any major postoperative adverse events. Results During the study period, 186 patients underwent resection for PDAC with curative intent. Pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were performed in 66%, 12%, and 22% of patients, respectively. Major 90-day postoperative morbidity and mortality rate were 21.5% and 4.3%, respectively. After excluding patients who died within 90 days, major postoperative morbidity significantly increased the length of hospital stay [median 22 (8-66) days vs. 13 (5-26) days, p &lt; 0.0001] resulting in a delay of returning to intended oncologic treatment and reducing the likelihood of receiving adjuvant chemotherapy (56% vs. 83%, p = 0.001). Postoperative major complications were associated with significantly worse DFS (median DFS 10 vs. 16 months, hazard ratio 1.9, 95% confidence interval 1.91-2.96, p = 0.004) and worse OS (median OS 14 vs. 37 months, hazard ratio 1.7, 95% confidence interval 1.02-2.75, p = 0.04) in multivariate analysis. Conclusion Major postoperative complications promote tumor recurrence following resection for PDAC, thus limiting long-term survival. Careful patient selection and optimized complication management may reduce postoperative morbidity, thereby lowering its negative impact on oncologic prognosis.

Short-term weight loss after hospitalization predicts long-term survival in patients with chronic heart failure

2006 ◽  
Vol 31 (03) ◽  
Author(s):  
M Lainscak ◽  
S von Haehling ◽  
A Sandek ◽  
I Keber ◽  
M Kerbev ◽  
...  
Keyword(s):  
Heart Failure ◽  
Weight Loss ◽  
Chronic Heart Failure ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival

Cancer related nutritional and inflammatory markers as predictive parameters of immediate postoperative complications and long-term survival after hepatectomies

2021 ◽  
Vol 37 ◽  
pp. 101526
Author(s):  
Sohan Lal Solanki ◽  
Jasmeen Kaur ◽  
Amit M. Gupta ◽  
Shraddha Patkar ◽  
Riddhi Joshi ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Inflammatory Markers ◽  
Term Survival ◽  
Long Term Survival ◽  
Predictive Parameters
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