World Journal of Surgery

, Volume 39, Issue 1, pp 216–222 | Cite as

Major Post-Operative Complications Predict Long-Term Survival After Esophagectomy in Patients with Adenocarcinoma of the Esophagus

  • Guillaume LucEmail author
  • Marlène Durand
  • Laurence Chiche
  • Denis Collet
Original Scientific Report



Esophagectomy provides the best opportunity for a long-term cure despite its high post-operative morbidity. We reviewed our institutional records to evaluate the impact of major post-operative complications on the long-term survival of patients following esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma.


We identified 241 patients who underwent esophagectomy as a curative procedure at our tertiary referral center. All consecutive patients with locally advanced adenocarcinoma of the esophagus who underwent neoadjuvant treatment followed by esophagectomy were analyzed. Complications were graded according to the Clavien scale. Patients were compared according to the complication grade (grades 0–1–2 vs. grades 3–4). Overall survival and disease-free survival were calculated using the Kaplan–Meier method, and survival curves were compared using log-rank tests. Factors predictive of survival were determined using multivariate analysis.


A total of 116 patients underwent esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma of the esophagus. Fifty-four patients (46.5 %) developed post-operative complications. The post-operative mortality rate was 4.3 % (five patients). Patients with grade 3–4 complications had decreased overall survival and disease-free survival rates (p = 0.006 and 0.045). Grade 3–4 complications and positive nodes were found to be contributing factors to survival (p = 0.027 and 0.005).


Our single-institution study found that major morbidity had a negative impact on long-term survival in patients who underwent esophagectomy after neoadjuvant treatment for locally advanced adenocarcinoma.


Overall Survival Docetaxel Positive Node Esophageal Carcinoma Lower Esophagus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No grant support was received.

Conflicts of interest

No conflicts of interest exist.


  1. 1.
    Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62(1):10–29PubMedCrossRefGoogle Scholar
  2. 2.
    Berrino F, De Angelis R, Sant M et al (2007) Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995–99: results of EUROCARE-4 study. Lancet Oncol 8:773–783PubMedCrossRefGoogle Scholar
  3. 3.
    Allum WH, Stenning SP, Bancewicz J et al (2009) Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol 27:5062–5067PubMedCrossRefGoogle Scholar
  4. 4.
    Blom RL, van Heijl M, Bemelman WA et al (2013) Initial experiences of an enhanced recovery protocol in esophageal surgery. World J Surg 37(10):2372–2378. doi: 10.1007/s00268-013-2135-1 PubMedCrossRefGoogle Scholar
  5. 5.
    Swisher SG, Deford L, Merriman KW et al (2000) Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer. J Thorac Cardiovasc Surg 119:1126–1132PubMedCrossRefGoogle Scholar
  6. 6.
    Hulscher JB, van Sandick JW, de Boer AG et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347:1662–1669PubMedCrossRefGoogle Scholar
  7. 7.
    Sauvanet A, Mariette C, Thomas P et al (2005) Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg 201:253–262PubMedCrossRefGoogle Scholar
  8. 8.
    Lerut T, Moons J, Coosemans W et al (2009) Postoperative complications after transthoracic esophagectomy for cancer of the esophagus and gastroesophageal junction are correlated with early cancer recurrence. Ann Surg 250:798–807PubMedCrossRefGoogle Scholar
  9. 9.
    Lagarde SM, de Boer JD, ten Kate FJ et al (2008) Postoperative complications after esophagectomy for adenocarcinoma of the esophagus are related to timing of death due to recurrence. Ann Surg 247:71–76PubMedCrossRefGoogle Scholar
  10. 10.
    Rizk NP, Bach PB, Schrag D et al (2004) The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coll Surg 198:42–50PubMedCrossRefGoogle Scholar
  11. 11.
    Xia BT, Rosato EL, Chojnacki KA et al (2013) Major perioperative morbidity does not affect long-term survival in patients undergoing esophagectomy for cancer of the esophagus or gastroesophageal junction. World J Surg 37:408–415. doi: 10.1007/s00268-012-1823-6 PubMedCrossRefGoogle Scholar
  12. 12.
    Ferri LE, Law S, Wong KH et al (2006) The influence of technical complications on postoperative outcome and survival after esophagectomy. Ann Surg Oncol 13:557–564PubMedCrossRefGoogle Scholar
  13. 13.
    Ancona E, Cagol M, Epifani M et al (2006) Surgical complications do not affect long-term survival after esophagectomy for carcinoma of the thoracic esophagus and cardia. J Am Coll Surg 203:661–669PubMedCrossRefGoogle Scholar
  14. 14.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Alexious C, Khan OA, Black E et al (2006) Survival after esophageal resection for carcinoma: the importance of the histologic cell type. Ann Thorac Surg 82:1073–1077CrossRefGoogle Scholar
  16. 16.
    Sjoquist KM, Burmeister BH, Smithers BM et al (2011) Survival after neoadjuvant chemotherapy or chemoradiotherapy for resectable oesophageal carcinoma: an updated meta-analysis. Lancet Oncol 12:681–692PubMedCrossRefGoogle Scholar
  17. 17.
    Zanoni A, Verlato G, Giacopuzzi S et al (2013) Neoadjuvant concurrent chemoradiotherapy for locally advanced esophageal cancer in a single high-volume center. Ann Surg Oncol 20:1993–1999PubMedCrossRefGoogle Scholar
  18. 18.
    Edge SB, Byrd DR, Compton CC et al (2010) AJCC cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
  19. 19.
    Collet D, Mariette C, Meunier B (2013) Résultats. In: Cancer de l’œsophage, Arnette. Wolters Kluwer France, Paris, pp 167–178Google Scholar
  20. 20.
    Stahl M, Mariette C, Haustermans K, Cervantes A, Arnold D, on behalf of the ESMO guidelines working group (2013) Oesophageal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(6):51–56Google Scholar
  21. 21.
    Dindo D, Clavien PA (2008) What is a surgical complication? World J Surg 32:939–941. doi: 10.1007/s00268-008-9584-y PubMedCrossRefGoogle Scholar
  22. 22.
    Kinugasa S, Tachibana M, Yoshimura H et al (2004) Postoperative pulmonary complications are associated with worse short and long-term outcomes after extended esophagectomy. J Surg Oncol 88:71–77PubMedCrossRefGoogle Scholar
  23. 23.
    D’Annoville T, D’Journo XB, Trousse D et al (2012) Respiratory complications after oesophagectomy for cancer do not affect disease-free survival. Eur J Cardiothorac Surg 41:e66–e73PubMedCrossRefGoogle Scholar
  24. 24.
    Balkwill F, Mantovani A (2001) Inflammation and cancer: back to Virchow? Lancet 357:539–545PubMedCrossRefGoogle Scholar
  25. 25.
    Mantovani A, Allavena P, Sica A et al (2008) Cancer-related inflammation. Nature 454:436–444PubMedCrossRefGoogle Scholar
  26. 26.
    Wang JM, Chertov O, Proost P et al (1998) Purification and identification of chemokines potentially involved in kidney-specific metastasis by a murine lymphoma variant: induction of migration and NFkB activation. Int J Cancer 75:900–907PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  • Guillaume Luc
    • 1
    Email author
  • Marlène Durand
    • 2
  • Laurence Chiche
    • 1
  • Denis Collet
    • 1
  1. 1.Department of Digestive SurgeryUniversity Hospital of BordeauxBordeauxFrance
  2. 2.CIC-IT, Hospital Xavier ArnozanUniversity Hospital of BordeauxBordeauxFrance

Personalised recommendations