The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma Journal Article
| Authors: | Rizk, N. P.; Bach, P. B.; Schrag, D.; Bains, M. S.; Turnbull, A. D.; Karpeh, M.; Brennan, M. F.; Rusch, V. W. |
| Article Title: | The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma |
| Abstract: | BACKBROUND: Efforts to improve surgical outcomes have traditionally focused on improving preoperative patient selection and reducing the risk of postoperative medical complications. Strategies to optimize surgical technique have been less well studied. We sought to assess the relation between complications related to surgical technique and outcomes after esophagogastrectomy for cancer. STUDY DESIGN: Medical records of 510 consecutive patients undergoing esophagogastrectomy for invasive squamous cell carcinoma or adenocarcinoma at Memorial Sloan-Kettering Cancer Center from 1996 to 2001 were reviewed. Data on diagnosis, stage of disease, therapies received, surgical approach, patient comorbidities, technical complications, and postoperative medical complications and outcomes including length of stay and overall survival were determined by one reviewer of the medical records. The primary predictor was surgical complications and the primary outcome was survival. RESULTS: Of the 150 patients studied 138 (27%) had complications directly attributable to surgical technique, such as an anastomotic leak, a paralyzed vocal cord, or chylothorax. At 3 years 43 of 138 patients (31%) with technical complications were alive, whereas 179 of 372 patients (48%) without technical complications were alive. Technical complications were associated with increased length of stay (median 23 days versus 11 days, p < 0.001), increased in-hospital mortality (12.3% versus 3.8%, p < 0.001), and a higher rate of medical complications (77.5% versus 47.3%, p < 0.001). After controlling for age, medical comorbidities, use of induction therapy, tumor stage, histology, and location, and completeness of resection the presence of a technical complication was highly predictive of poorer overall survival; the multivariable hazard ratio was 1.41 (1.22 to 1.63, p = 0.008). CONCLUSIONS: Technical complications have a large negative impact on survival after esophagogastrectomy for cancer. Strategies to optimize surgical technique and minimize complications should improve outcomes in this cancer operation. © 2004 by the American College of Surgeons. |
| Keywords: | adult; cancer survival; controlled study; treatment outcome; aged; middle aged; survival analysis; cancer surgery; surgical technique; retrospective studies; major clinical study; mortality; squamous cell carcinoma; carcinoma, squamous cell; adenocarcinoma; postoperative complication; postoperative complications; length of stay; thromboembolism; surgical risk; comorbidity; transient ischemic attack; nerve injury; outcome and process assessment (health care); gastrectomy; outcomes research; multivariate analysis; heart arrhythmia; psychosis; second look surgery; vocal cord paralysis; esophagus carcinoma; lung infiltrate; esophageal neoplasms; esophagectomy; lower esophagus sphincter; cerebrovascular accident; respiratory failure; recurrent laryngeal nerve; esophagogastric junction; anastomosis leakage; esophagogastrectomy; chylothorax; creatine kinase mb; humans; human; male; female; priority journal; article; diaphragm hernia; gastroesophageal junction carcinoma |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 198 |
| Issue: | 1 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2004-01-01 |
| Start Page: | 42 |
| End Page: | 50 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2003.08.007 |
| PROVIDER: | scopus |
| PUBMED: | 14698310 |
| DOI/URL: | |
| Notes: | J. Am. Coll. Surg. -- Cited By (since 1996):156 -- Export Date: 16 June 2014 -- CODEN: JACSE -- Source: Scopus |
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