scholarly journals Determinants of Long-Term Survival After Major Surgery and the Adverse Effect of Postoperative Complications

Author(s):  
Shukri F. Khuri ◽  
William G. Henderson ◽  
Ralph G. DePalma ◽  
Cecilia Mosca ◽  
Nancy A. Healey ◽  
...  
2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Clara Santos ◽  
Laura Santos ◽  
Leticia Datrino ◽  
Guilherme Tavares ◽  
Luca Tristão ◽  
...  

Abstract   During esophagectomy for cancer, there is no consensus if prophylactic thoracic duct ligation (TDL), with or without thoracic duct resection (TDR), could influence the perioperative outcomes and long-term survival. This systematic review and meta-analysis compared patients who went through esophagectomy associated or not to ligation or resection of the thoracic duct. Methods A systematic review was conducted in PubMed, Embase, Cochrane Library Central and Lilacs (BVS). The inclusion criteria were: (1) studies that compare thoracic duct ligation, with or without resection, and non-thoracic duct ligation; (2) involve adult patients with esophageal cancer; (3) articles that analyses the outcomes—perioperative complications, perioperative mortality, chylothorax development and overall survival; (4) only clinical trials and cohort were accepted. A 95% confidence interval (CI) was used, and random-effects model was performed. Results Fifteen articles were selected, comprising 6,249 patients. TDL did not reduce the risk for chylothorax (Risk difference [RD]: -0.01; 95%CI: −0.02, 0.00). Also, TDL did not influence the risk for complications (RD: -0.02; 95%CI: −0.11, 0.07); mortality (RD: 0.00; 95%CI: −0.00, 0.00); and reoperation rate (RD: -0.01; 95%CI: −0.02, 0.00). TDR was associated with higher risk for postoperative complications (RD: 0.1; 95%CI 0.00, 0.19); chylothorax (RD: 0.02; 95%CI 0.00, 0.03). Both TDL and TDR did not influence the overall survival rate (TDL: HR: 1.17; 95%CI: 0.86, 1.48; and TDR: HR: 1.16; 95%CI: 0.8, 1.51). Conclusion Thoracic duct obliteration with or without its resection during esophagectomy does not change long term survival. Nonetheless, TDR increased the risk for postoperative complications and chylothorax.


Pancreatology ◽  
2019 ◽  
Vol 19 (5) ◽  
pp. 686-694 ◽  
Author(s):  
Naoya Kasahara ◽  
Hiroshi Noda ◽  
Nao Kakizawa ◽  
Takaharu Kato ◽  
Fumiaki Watanabe ◽  
...  

Author(s):  
Susumu Mochizuki ◽  
Hisashi Nakayama ◽  
Yutaka Midorikawa ◽  
Tokio Higaki ◽  
Masamichi Moriguchi ◽  
...  

Objective The effect of postoperative complications including red blood transfusion (BT) on long-term survival for hepatocellular carcinoma (HCC) is unknown. The purpose of this study was to define the relationship between postoperative complications and long-term survival in patients with HCC. Methods Postoperative complications of 1251 patients who underwent curative liver resection for HCC were classified, and their recurrence-free survival (RFS) and cumulative overall survival (OS) were investigated. Results Any complications occurred in 503 patients (40%). Five-year RFS and 5-year OS in the complication group were 21% and 56%, respectively, significantly lower than the respective values of 32% ( p < 0.001) and 68% ( p < 0.001) in the no-complication group (n=748). Complications related to RFS were postoperative BT [Hazard ratio (HR): 1.726, 95% confidence interval (CI): 1.338–2.228, p < 0.001], pleural effusion [HR: 1.434, 95% CI: 1.200–1.713, p < 0.001] using Cox-proportional hazard model. Complications related to OS were postoperative BT [HR: 1.843, 95%CI: 1.380-2.462, p < 0.001], ascites [HR: 1.562, 95% CI: 1.066–2.290 p = 0.022], and pleural effusion [HR: 1.421, 95% CI: 1.150–1.755, p = 0.001). Conclusions Postoperative complications were factors associated with poor long-term survival. Postoperative BT and pleural effusion, were noticeable complications that were prognostic factors for both recurrence-free survival and overall survival.


2013 ◽  
Vol 56 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Karl Mrak ◽  
Thomas Eberl ◽  
Andreas Laske ◽  
Michael Jagoditsch ◽  
Josef Fritz ◽  
...  

2018 ◽  
Vol 25 (13) ◽  
pp. 3874-3882 ◽  
Author(s):  
Linda B. M. Weerink ◽  
Christina M. Gant ◽  
Barbara L. van Leeuwen ◽  
Geertruida H. de Bock ◽  
Ewout A. Kouwenhoven ◽  
...  

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R Alfieri ◽  
M Nardi ◽  
V Moretto ◽  
E Pinto ◽  
M Briarava ◽  
...  

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.


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