Background: Esophageal cancer is the eighth most common cancer and the sixth most common cause of death from cancer. Esophagectomy is still the essential treatment for esophageal cancer despite its high morbidity rate. The prediction of complications that are likely to appear after surgery can be the most critical factor in reducing morbidity.
Objective: The present study aimed to examine the postoperative complications and causes of mortality in patients undergoing esophagectomy for esophageal cancer.
Material and Methods: Data from 34 patients with esophageal adenocarcinoma or squamous cell carcinoma undergoing esophagectomy in the general surgery clinic of Çukurova University Medical School Hospital were collected and analyzed retrospectively between January 1, 2011, and January 1, 2020. Postoperative complications were identified according to the Clavien-Dindo classification (CD). The patients were assigned into two groups (Group 1 and Group 2). Group 1 and Group 2 included patients with CD grade <3 and CD grade , respectively.
Results: The mean±SD age of patients (n=34) undergoing resection for esophageal cancer was obtained at 56.38±11.00 years. The ratio of female to male patients was equal. The most common accompanying disease was diabetes mellitus. The number of patients with the American Society of Anesthesiologists score 3 was higher in Group 2 (P=0.034). The tumor was most frequently located in the lower thoracic esophagus of patients in Group 1 and Group 2, and the rate of cervical anastomosis was higher in Group 2. The rate of manual anastomosis was higher in both groups. Respiratory complications were the most frequent complication in both groups; however, a higher rate of respiratory complications was observed in Group 2 (P=0.038). The postoperative 30-days mortality and the reoperation rate were higher in Group 2.
Conclusion: Radical surgery for esophageal cancer results in a high rate of complications and death due to the location of the tumor and diagnosis at the advanced stage. Complications and mortality may result from patient-related factors and the surgical technique. The diagnosis and treatment of the correctable causes before surgery can enhance the chance of survival and the quality of life in patients.
- Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108. doi: 10.3322/caac.21262. [PubMed: 25651787].
- Tuncer İ, Uygan İ, Kösem M, Özen S, Uğraş S, Türkdoğan K. Van ve çevresinde görülen üst gastrointestinal sistem kanserlerinin demografik ve histopatolojik özellikleri. Van Tıp Dergisi. 2001;8(1):10.
- Jafarian AH, Forooshani MK, Takallou L, Roshan NM. CD10 expression in gastric carcinoma is correlated with tumor grade and survival. Universa Medicina. 2019;38(1):41-7. doi: 10.18051/UnivMed.2019.v38.41-47
- Tahara E. Genetic alterations in human gastrointestinal cancers. The application to molecular diagnosis. Cancer. 1995;75(6 Suppl):1410-7. doi: 10.1002/1097-0142(19950315)75:6+<1410::aid-ncr2820751504>3.0.co;2-o. [PubMed: 7889467].
- Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae. [PubMed: 15273542].
- : American College of Surgeons National Surgical Quality 2012 [cited 2021 oct26]. Available from: https://www.facs.org/-/media/files/quality-programs/nsqip/ug12.ashx
- Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control. 1992;20(5):271-4. doi: 10.1016/s0196-6553(05)80201-9. [PubMed: 1332552].
- Vetter D, Gutschow CA. Strategies to prevent anastomotic leakage after esophagectomy and gastric conduit reconstruction. Langenbecks Arch Surg. 2020;405(8):1069-77. doi: 10.1007/s00423-020-01926-8. [PubMed: 32651652].
- Park SY, Hong MH, Kim HR, Lee CG, Cho JH, Cho BC, et al. The feasibility and safety of radical esophagectomy in patients receiving neoadjuvant chemoradiotherapy with pembrolizumab for esophageal squamous cell carcinoma. J Thorac Dis. 2020;12(11):6426-34. doi: 10.21037/jtd-20-1088. [PubMed: 33282345].
- Cooper GJ, Sherry KM, Thorpe JA. Changes in gastric tissue oxygenation during mobilisation for oesophageal replacement. Eur J Cardiothorac Surg. 1995;9(3):158-60; discussion 60. doi: 10.1016/s1010-7940(05)80065-x. [PubMed: 7786534].
- Abunasra H, Lewis S, Beggs L, Duffy J, Beggs D, Morgan E. Predictors of operative death after oesophagectomy for carcinoma. Br J Surg. 2005;92(8):1029-33. doi: 10.1002/bjs.5049. [PubMed: 15931662].
- Ferguson MK, Martin TR, Reeder LB, Olak J. Mortality after esophagectomy: risk factor analysis. World J Surg. 1997;21(6):599-603; discussion -4. doi: 10.1007/s002689900279. [PubMed: 9230656].
- Hutchins LF, Unger JM, Crowley JJ, Coltman CA, Jr., Albain KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med. 1999;341(27):2061-7. doi: 10.1056/NEJM199912303412706. [PubMed: 10615079].
- Kinugasa S, Tachibana M, Yoshimura H, Dhar DK, Shibakita M, Ohno S, et al. Esophageal resection in elderly esophageal carcinoma patients: improvement in postoperative complications. Ann Thorac Surg. 2001;71(2):414-8. doi: 10.1016/s0003-4975(00)02333-x. [PubMed: 11235680].
- Ma JY, Wu Z, Wang Y, Zhao YF, Liu LX, Kou YL, et al. Clinicopathologic characteristics of esophagectomy for esophageal carcinoma in elderly patients. World J Gastroenterol. 2006;12(8):1296-9. doi: 10.3748/wjg.v12.i8.1296. [PubMed: 16534889].
- Nakajo M, Kitajima K, Kaida H, Morita T, Minamimoto R, Ishibashi M, et al. The clinical value of PERCIST to predict tumour response and prognosis of patients with oesophageal cancer treated by neoadjuvant chemoradiotherapy. Clin Radiol. 2020;75(1):79 e9- e18. doi: 10.1016/j.crad.2019.09.132. [PubMed: 31662200].
- Wang SL, Liao Z, Vaporciyan AA, Tucker SL, Liu H, Wei X, et al. Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery. Int J Radiat Oncol Biol Phys. 2006;64(3):692-9. doi: 10.1016/j.ijrobp.2005.08.002. [PubMed: 16242257].
- Türkdoğan M. Doğu Anadolu Bölgesinde üst gastrointestinal kanserlerinde beslenme ve çevre ile ilgili risk faktörleri. Hepato-gastroenteroloji sempozyumu. 2003. doi: 10.1136/bmj.327.7425.1192. [PubMed: 14630753].
- McCulloch P, Ward J, Tekkis PP, surgeons Ago, British Oesophago-Gastric Cancer G. Mortality and morbidity in gastro-oesophageal cancer surgery: initial results of ASCOT multicentre prospective cohort study. BMJ. 2003;327(7425):1192-7. doi: 10.1136/bmj.327.7425.1192. [PubMed: 14630753].
- Wright CD, Kucharczuk JC, O'Brien SM, Grab JD, Allen MS, Society of Thoracic Surgeons General Thoracic Surgery D. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg. 2009;137(3):587-95; discussion 96. doi: 10.1016/j.jtcvs.2008.11.042. [PubMed: 19258071].
- Ando N, Kato H, Igaki H, Shinoda M, Ozawa S, Shimizu H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19(1):68-74. doi: 10.1245/s10434-011-2049-9. [PubMed: 21879261].
- van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med. 2012;366(22):2074-84. doi: 10.1056/NEJMoa1112088. [PubMed: 22646630].
- Zhang Z, Zhang H. Impact of neoadjuvant chemotherapy and chemoradiotherapy on postoperative cardiopulmonary complications in patients with esophageal cancer. Dis Esophagus. 2017;30(4):1-7. doi: 10.1093/dote/dox002. [PubMed: 28375486].
- Chasseray VM, Kiroff GK, Buard JL, Launois B. Cervical or thoracic anastomosis for esophagectomy for carcinoma. Surg Gynecol Obstet. 1989;169(1):55-62. [PubMed: 2740970].
- Gooszen JAH, Goense L, Gisbertz SS, Ruurda JP, van Hillegersberg R, van Berge Henegouwen MI. Intrathoracic versus cervical anastomosis and predictors of anastomotic leakage after oesophagectomy for cancer. Br J Surg. 2018;105(5):552-60. doi: 10.1002/bjs.10728. [PubMed: 29412450].
- Wang BY, Hung WH, Wu SC, Chen HC, Huang CL, Lin CH, et al. Comparison Between Esophagectomy and Definitive Chemoradiotherapy in Patients With Esophageal Cancer. Ann Thorac Surg. 2019;107(4):1060-7. doi: 10.1016/j.athoracsur.2018.11.036. [PubMed: 30571951].
- Viklund P, Lindblad M, Lu M, Ye W, Johansson J, Lagergren J. Risk factors for complications after esophageal cancer resection: a prospective population-based study in Sweden. Ann Surg. 2006;243(2):204-11. doi: 10.1097/01.sla.0000197698.17794.eb. [PubMed: 16432353].