O193 ROLE OF MALNUTRITION IN 0ESOPHAGEAL SURGERY FOR CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R Alfieri ◽  
M Nardi ◽  
V Moretto ◽  
E Pinto ◽  
M Briarava ◽  
...  
Keyword(s):  
Weight Loss ◽  
Postoperative Complications ◽  
Nutritional Status ◽  
Term Survival ◽  
Long Term Outcome ◽  
Long Term Survival ◽  
Oesophagogastric Junction ◽  
Significant Difference ◽  
The Impact

Abstract Aim To investigate whether preoperative malnutrition is associated with long term outcome and survival in patients undergoing radical oesophagectomy for oesophageal or oesophagogastric junction cancer. Background & Methods Dysphagia, weight loss, chemo-radiationtherapy frequently lead to malnutrition in patients with oesophageal or oesophagogastric junction cancer. Severe malnutrition is associated with higher risk of postoperative complications but little is known on the correlation with long term survival. We conducted a single center retrospective study on a prospectively collected database of patients undergoing oesophagectomy from 2008 and 2012 in order to evaluate the impact of preoperative malnutrition with postoperative outcome and long term survival. Preoperative malnutrition was classified as: prealbumin level less than 220 mg/dL (PL), MUST index (Malnutrition Universal Screeening Tool) >2 and weight loss >10%. Results 177 consecutive patients were considered: due to incomplete data 60 were excluded from the analysis that was performed on 117 patients. PL was reported in 52 (44%) patients, MUST index was recorded in 62 (53%), 58 (49%) patients presented more than 10% weight loss at the preoperative evaluation. PL was associated with more postoperative Clavien-Dindo 1-2 complications (p=0.048, OR 2.35 95%IC 1.001-5.50), no differences were observed in mortality, anastomotic leak, major pulmonary complications. MUST index was not correlated with postoperative complications nor mortality but resulted worse in patients treated with chemo-radiotherapy (p=0.046, OR 1.92 95%CI 1.011-3.64). Weight loss >10% was not associated with postoperative complications or mortality. Overall 7 years survival rate was 69%. and DFS was 68%. Malnourished patients did not differ from non-malnourished regarding age, sex, tumor site, tumor stage and histology. No significant difference in 7 years survival rates was observed in patients with PL <220 mg/dL ( 55 % vs 67%), neither in patients with MUST score>2 (58% vs 72%), nor in patients with weight loss >10% (53% vs 70%). Conclusions Malnutrition is more common in patients treated with chemoradiation therapy and it is associated with postoperative complications. However, both long term and disease free survival are not affected by preoperative nutritional status. Larger patient population and data on long term postoperative nutritional status will be analyzed in further studies.

The Impact of Major Postoperative Complications on Long-Term Survival After Cardiac Surgery

2020 ◽  
Vol 110 (1) ◽  
pp. 128-135 ◽  
Author(s):  
Laura Seese ◽  
Ibrahim Sultan ◽  
Thomas G. Gleason ◽  
Forozan Navid ◽  
Yisi Wang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Postoperative Complications ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

Diabetes mellitus and survival of esophageal cancer patients after esophagectomy: a systematic review and meta-analysis

2020 ◽  
Vol 33 (2) ◽  
Author(s):  
Xi Zheng ◽  
Xingsheng Ma ◽  
Han-Yu Deng ◽  
Panpan Zha ◽  
Jie Zhou ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Esophageal Cancer ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Outcome Data ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
The Impact

SUMMARY Diabetes mellitus (DM) is one of the most common comorbidities in esophageal cancer patients who undergo esophagectomy. It is well established that DM has an unfavorable impact on short-term outcomes of patients with surgically treated esophageal cancer; however, whether DM has any impact on long-term survival of these patients remains unclear. We performed the first meta-analysis to investigate the impact of DM on survival of surgically treated esophageal cancer patients. We searched the following databases systematically to retrieve relevant studies on January 2, 2019: PubMed, Embase, and Web of Science. The main outcome data consisting of 3- and 5-year overall survival (OS) rates and hazard ratios (HRs) of OS were extracted to compare survival between patients with and without DM. We finally included for meta-analysis a total of eight cohort studies involving 5,044 esophageal cancer patients who underwent esophagectomy. We found no significant difference between 3-year (risk ratio [RR] = 0.94, 95% CI: 0.73–1.21; P = 0.65) and 5-year (RR = 0.92, 95% CI: 0.80–1.08; P = 0.31) OS rates between patients with and without DM after esophagectomy. Moreover, DM was not found to be an independent predictor of OS for these patients (HR = 1.10, 95% CI: 0.65–1.84; P = 0.72). Our study suggests that DM appears to have no significant impact on long-term survival of esophageal cancer patients who undergo esophagectomy. To improve the prognosis of these patients, it may be more important to control glycemic level in patients with DM who undergo esophagectomy. However, further high-quality studies with appropriate adjustment for confounding factors are needed to verify this conclusion.

PS02.167: IMPACT OF POSTOPERATIVE COMPLICATIONS AFTER RESECTION OF ESOPHAGUS FOR CARCINOMA ON LONG-TERM SURVIVAL

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 169-169
Author(s):  
Martin Snajdauf ◽  
Tomas Harustiak ◽  
Alexandr Pazdro ◽  
Robert Lischke
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Postoperative Complications ◽  
Conflicts Of Interest ◽  
Neoadjuvant Treatment ◽  
Chyle Leak ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

Abstract Background Esophagectomy with 2–3 field lymph node dissection is one of the most invasive surgical treatment for malignancy and is still associated with a high mortality and morbidity despite improvements in surgical techniques and postoperative management. The impact of postoperative complications on perioperative morbidity is widely accepted. But the impact of postoperative complications on long-term survival remains controversial. Methods A retrospective analysis was performed on patient who underwent transthoracic esophagectomy with intrathoracic anastomosis for esophageal cancer between January 2005 and December 2012 in our department (415 patients). We excluded non-radical resections (R1, R2 – 27 patients, 6.5%) and patients who died within 90 day after operation (20 patients, 4.8%). Data on gender, BMI, histologic diagnosis, tumor staging, neoadjuvant treatment, comorbidities, technical complications and postoperative medical complications were reviewed. Considered postoperative complications were anastomotic leak, empyema, chyle leak, pneumonia, ARDS, cardiac arrhythmia, wound infection and urinary tract infection. We analysed separately extrapolated serious complications Clavien Dindo 3–4 and their possible impact on overall survival. Prognostic factors were assessed by multivariate analysis. Results Total number of analysed patients was 363. The median follow up was 8.5 years. From the baseline characteristics, the presence of atrial fibrillation (P = 0.0157, HR 2.376) and hypertension (P = 0.0093, HR 1.488), higher staging pT3–4 (0.0146, HR 1.437) and presence of lymph node metastasis pN + (P < 0.001, HR 2.263) had a negative impact on overall survival. Among the postoperative complications, only chyle leak (P = 0.0327, HR 4.023) had a negative prognostic factor on overall survival. Conclusion In this single institution series, among the postoperative complications only chylothorax affect negatively the overall survival. Accurate ligation of resected thoracic duct stumps to minimize chyle leak is important to improve outcomes. The influence of others postoperative complications wasn’t significant. We assume important to exclude postoperative mortality from analysis to prevent bias. Disclosure All authors have declared no conflicts of interest.

scholarly journals Impact of Type of Postoperative Complications on Long-Term Survival of Gastric Cancer Patients: Results From a High-Volume Institution in China

2021 ◽  
Vol 11 ◽  
Author(s):  
Hua-Yang Pang ◽  
Lin-Yong Zhao ◽  
Hui Wang ◽  
Xiao-Long Chen ◽  
Kai Liu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Postoperative Complications ◽  
Negative Impact ◽  
Infectious Complications ◽  
Curative Gastrectomy ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

BackgroundThis study aimed to evaluate the impact of postoperative complication and its etiology on long-term survival for gastric cancer (GC) patients with curative resection.MethodsFrom January 2009 to December 2014, a total of 1,667 GC patients who had undergone curative gastrectomy were analyzed. Patients with severe complications (SCs) (Clavien–Dindo grade III or higher complications or those causing a hospital stay of 15 days or longer) were separated into a “complication group.” Univariate and multivariate analyses were performed to reveal the relationship between postoperative complications and long-term survival. A 2:1 propensity score matching (PSM) was used to balance baseline parameters between the two groups.ResultsSCs were diagnosed in 168 (10.08%) patients, including different etiology: infectious complications (ICs) in 111 (6.66%) and non-infectious complications (NICs) in 71 (4.26%) patients. Multivariate analysis showed that presence of SCs (P=0.001) was an independent prognostic factor for overall survival, and further analysis by complication type demonstrated that the deteriorated overall survival was mainly caused by ICs (P=0.004) rather than NICs (P=0.068). After PSM, patients with SCs (p=0.002) still had a significantly decreased overall survival, and the presence of ICs (P=0.002) rather than NICs (P=0.067) showed a negative impact on long-term survival.ConclusionSerious complications, particularly of an infectious type, may have a negative impact on overall survival of GC patients. However, additional multicenter prospective studies with larger sample size are required to verify this issue.

P159 THE IMPACT OF POSTOPERATIVE COMPLICATIONS ON LONG-TERM SURVIVAL AND DISEASE RECURRENCE FOLLOWING OESOPHAGO-GASTRIC CANCER RESECTION

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
J H Saunders ◽  
F Yanni ◽  
M S Dorrington ◽  
C R Bowman ◽  
R S Vohra ◽  
...  
Keyword(s):  
Overall Survival ◽  
Postoperative Complications ◽  
Disease Free Survival ◽  
Disease Recurrence ◽  
Term Survival ◽  
Free Survival ◽  
Long Term Survival ◽  
The Impact ◽  
Disease Free

Abstract Aim Postoperative complications following the resection of oesophago-gastric carcinoma can result in considerable early morbidity and mortality, however the long-term effects are less clear. Literature reports are mixed, so it remains unclear if complications reduce survival, as has been demonstrated in colorectal cancer. Background & Methods Some 1100 patients who underwent oesophago-gastric resection between 2006-16 were stratified by complication severity to determine the effect of leak and severe non-leak related complications on overall survival, recurrence and disease free survival. Results The median age was 69 years, 48% had stage III disease, with cancer recurrence in 39%. Clavien-Dindo (CD) complications ≥ III occurred in 22.2% of patients. The most common complications were pulmonary (30%), with a 13% incidence of pneumonia, 10% atrial dysrhythmia and 9.6% anastomotic leak. In comparison to CD 0-I complication free patients, those with CD III-IV leak did not suffer a significantly reduced survival. However patients with CD III-IV non-leak related complications were associated with a significant reduction in median overall survival (19.7 vs. 42.7 months) and disease free survival (18.4 vs. 36.4 months). Cox regression revealed age, stage, resection margin, and CD III-IV non-leak complications as independently associated with poor overall and disease free survival. Conclusion This cohort demonstrates that whilst leak does not affect long-term survival, other severe postoperative complications do significantly reduce overall survival and disease recurrence. A reduction in these complications, such as pneumonia, seen with adoption of hybrid / minimally invasive surgery may help change this pattern of disease recurrence and reduced survival.

scholarly journals Long-term survival in patients who had CABG with or without prior coronary artery stenting

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001160
Author(s):  
Pratik Rai ◽  
Rebecca Taylor ◽  
Mohamad Nidal Bittar
Keyword(s):  
Coronary Artery ◽  
Proportional Hazards ◽  
Bypass Graft ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Term Survival ◽  
Long Term Survival ◽  
Significant Difference ◽  
The Impact

ObjectiveTo conduct a large-scale, single-centre retrospective cohort study to understand the impact of prior percutaneous coronary intervention (PCI) on long-term survival of patients who then undergo coronary artery bypass graft (CABG).MethodsBetween 1999 and 2017, a total of 11 332 patients underwent CABG at a hospital in the UK. The patients were stratified into those who received PCI (n=1090) or no PCI (n=10 242) prior to CABG. A total of 1058 patients from each group were matched using propensity score matching. Kaplan-Meier estimates were used to assess risk-adjusted survival in patients with prior PCI. Cox proportional hazards (CoxPH) model was then used to assess the effect of prior PCI and other variables in patients undergoing CABG.ResultsThe immediate postoperative outcome showed no difference in number of grafts per patients, blood transfusion, hospital stay or 30 days mortality between the groups. There was no significant difference in 5 years (90.8% vs 87.9), 10-year (76.5% vs 74.6%) and 15-year (64.4% vs 64.7%) survival between the non-PCI versus PCI groups. The Cox proportional hazards model further supports the null hypothesis as the PCI variable was found to be non-significant (CoxPH=1.03, p=0.75, CI=0.87–1.22) implying there was no difference in hazard of death for CABG patients with or without previous PCI. However, the model did yield information on the covariates that do affect the hazard of death.ConclusionThere is no difference in 5-year, 10-year and 15-year survival between patients undergoing CABG with or without prior PCI. However, certain patient, preoperative and intraoperative risk factors were identified with high hazard of death which needs to be investigated further.

scholarly journals Impact of tricuspid valve regurgitation severity and its secondary reduction on long-term survival after transcatheter mitral valve edge-to-edge repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Geyer ◽  
K Keller ◽  
T Ruf ◽  
F Kreidel ◽  
A Petrescu ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Cox Regression ◽  
Valve Regurgitation ◽  
Term Survival ◽  
Long Term Outcome ◽  
Long Term Survival ◽  
Cox Regression Analysis ◽  
The Impact

Abstract Background Mitral valve regurgitation (MR) is a frequent heart valve disorder affecting 1–2% of the humans in the general population and over 10% of the individuals older than 75 years. While a symptomatic and prognostic benefit of transcatheter edge-to-edge repair for MR (TMVR) was reported, data regarding long-term outcome as well as influence of concomitant tricuspid regurgitation (TR) are sparse. Purpose We aimed to investigate the impact of periinterventional development of TR on survival of patients undergoing interventional edge-to-edge repair for MR in a large retrospective monocentric study. Methods We retrospectively analyzed survival of patients successfully treated with isolated edge-to-edge repair for MR from 06/2010–03/2018 (exclusion of combined forms of TMVR) in our center. Baseline, periprocedural as well as follow-up data were gathered. Concomitant TR was evaluated at baseline and after 30 days and categorized from grades 0 (no TR) to grade III (severe TR). We analyzed the influence of severe vs. non-severe TR on 30-day, 1-year and long-term survival. Results Overall, 627 consecutive patients (47.0% female, 57.4% functional MR) were enrolled. Median follow-up time was 462 days [IQR 142–945]. Survival status was available in 96.7%. Survival rates were 97.6% at discharge, 75.7% after 1, 54.5% after 3, 37.6% after 5 and 21.7% after 7 years. TR at baseline (examination results were available in 92.3%) was categorized as severe TR in 25.6%, medium TR in 33.3%, mild TR in 35.1% and no TR in 6.0%. TR at 1 month (examination results were available in 81.1%) was severe in 16.7%, medium in 30.2%, mild in 45.6% and no TR was found in 7.4%; improvement by at least 1 TR-grade was documented in 33.6% of the patients. While a severe (compared to non-severe) TR at baseline did not affect the 30-day mortality (7.4% vs. 5.2%, p=0.354), 1-year survival was substantially impaired in those patients (36.5% vs. 23.0%, p=0.012). Accordingly, severe TR was not associated with 30d-mortality (as evaluated by univariate Cox regression, p=0.340), but with 1-year survival (HR 1.78, 95% CI 1.19–2.65, p=0.005) and showed a trend towards impaired long-term survival (HR 1.30, 95% CI 0.96–1.76, p=0.089). While residual severe TR at one month did not influence 1-year-mortality significantly (p=0.478), improvement of TR demonstrated a trend to better survival after the first year (86.9 vs. 81.0%, p=0.208) confirmed in the Cox regression analysis (HR 0.66, 95% CI 0.36–1.22, p=0.188). Conclusions In this large retrospective monocentric study with a long-term follow-up-period of &gt;7 years after edge-to-edge therapy for MR, we demonstrated that severe TR at the time of the intervention had an impact on 1-year-survival. Furthermore, a missing periinterventional improvement of TR was shown to be unfavorable regarding the long-term survival of these patients. Funding Acknowledgement Type of funding source: None

P79 CRITICAL APPRAISAL ON THE IMPACT OF SMOKING STATUS ON PERIOPERATIVE MORBIDITY, MORTALITY AND LONG-TERM SURVIVAL FOLLOWING OESOPHAGECTOMY FOR OESOPHAGEAL CANCERS: A TERTIARY UNIT ANALYSIS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
K Kamarajah Sivesh ◽  
Navidi Maziar ◽  
Griffin S Michael ◽  
W Phillips Alexander
Keyword(s):  
Smoking Status ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
Anastomotic Leaks ◽  
Term Survival ◽  
Long Term Survival ◽  
Perioperative Morbidity ◽  
Significant Difference ◽  
The Impact

Abstract Aim This study aimed to characterise morbidity and mortality profile by smoking status in patients undergoing oesophagectomy for oesophageal cancers. Background Oesophagectomy remains the mainstay for curative treatment of oesophageal cancer. Despite improvements in perioperative care, little is understood on the impact of smoking status on perioperative morbidity and mortality following oesophagectomy for oesophageal cancers. Methods Consecutive patients undergoing oesophagectomy cancer (adenocarcinoma or squamous cell carcinoma) between 1997 - 2016 at the Northern Oesophagogastric Unit were included from a contemporaneously maintained database. Primary outcome was overall survival. Secondary outcomes include overall complications, anastomotic leaks and pulmonary complications. Results During the study period, 1207 patients underwent oesophagectomy for cancer. Of these 1207 patients, most were current (74%) smokers with only 20% non-smokers. Median survival of current smokers was significantly shorter than ex-smokers and non-smokers (median: 35 vs 42 vs 44 months, p=0.031). On adjusted analysis, there were no significant difference in survival between non-smokers and ex-smokers with current smokers. Rates of overall complications were significantly higher with current smokers compared to ex-smokers or non-smokers (73% vs 66% vs 62%, p=0.015). There were no significant differences in anastomotic leaks and pulmonary complications between the groups. Conclusion In summary, this study demonstrated that current smokers have significantly reduced long-term survival compared to ex-smokers or never smokers, specifically patients undergoing surgery only or those with SCC. Future studies in patients with neoadjuvant therapy to further delineate genetic landscape of oesophageal cancers to identify high risk groups that may warrant further multimodality therapy.

scholarly journals Double bypass for inoperable pancreatic malignancy at laparotomy: postoperative complications and long-term outcome

2012 ◽  
Vol 94 (8) ◽  
pp. 563-568 ◽  
Author(s):  
F Ausania ◽  
AE Vallance ◽  
DM Manas ◽  
JM Prentis ◽  
CP Snowden ◽  
...  
Keyword(s):  
High Risk ◽  
Postoperative Complications ◽  
Cardiopulmonary Exercise Testing ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Long Term Survival ◽  
Pancreatic Malignancy ◽  
Operative Severity Score

INTRODUCTION Between 4% and 13% of patients with operable pancreatic malignancy are found unresectable at the time of surgery. Double bypass is a good option for fit patients but it is associated with high risk of postoperative complications. The aim of this study was to identify pre-operatively which patients undergoing double bypass are at high risk of complications and to assess their long-term outcome. METHODS Of the 576 patients undergoing pancreatic resections between 2006 and 2011, 50 patients who underwent a laparotomy for a planned pancreaticoduodenectomy had a double bypass procedure for inoperable disease. Demographic data, risk factors for postoperative complications and pre-operative anaesthetic assessment data including the Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) and cardiopulmonary exercise testing (CPET) were collected. RESULTS Fifty patients (33 men and 17 women) were included in the study. The median patient age was 64 years (range: 39–79 years). The complication rate was 50% and the in-hospital mortality rate was 4%. The P-POSSUM physiology subscore and low anaerobic threshold at CPET were significantly associated with postoperative complications (p=0.005 and p=0.016 respectively) but they were unable to predict them. Overall long-term survival was significantly shorter in patients with postoperative complications (9 vs 18 months). Postoperative complications were independently associated with poorer long-term survival (p=0.003, odds ratio: 3.261). CONCLUSIONS P-POSSUM and CPET are associated with postoperative complications but the possibility of using them for risk prediction requires further research. However, postoperative complications following double bypass have a significant impact on long-term survival and this type of surgery should therefore only be performed in specialised centres.

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