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World Journal of Surgery

, Volume 37, Issue 2, pp 408–415 | Cite as

Major Perioperative Morbidity Does Not Affect Long-Term Survival in Patients Undergoing Esophagectomy for Cancer of the Esophagus or Gastroesophageal Junction

  • Brent T. Xia
  • Ernest L. Rosato
  • Karen A. Chojnacki
  • Albert G. Crawford
  • Benny Weksler
  • Adam C. BergerEmail author
Article

Abstract

Introduction

The incidence of cancer of the esophagus/GE junction is dramatically increasing but continues to have a dismal prognosis. Esophagectomy provides the best opportunity for long-term cure but is hampered by increased rates of perioperative morbidity. We reviewed our large institutional experience to evaluate the impact of postoperative complications on the long-term survival of patients undergoing resection for curative intent.

Methods

We identified 237 patients who underwent esophagogastrectomy, with curative intent, for cancer between 1994 and 2008. Complications were graded using the previously published Clavien scale. Survival was calculated using Kaplan–Meier methodology and survival curves were compared using log-rank tests. Multivariate analysis was performed with continuous and categorical variables as predictors of survival, and examined with logistic regression and odds ratio confidence intervals.

Results

There were 12 (5 %) perioperative deaths. The average age of all patients was 62 years, and the majority (82 %) was male. Complication grade did not significantly affect long-term survival, although patients with grade IV (serious) complications did have a decreased survival (p = 0.15). Predictors of survival showed that the minimally invasive type esophagectomy (p = 0.0004) and pathologic stage (p = 0.0007) were determining factors. There was a significant difference in overall survival among patients who experienced pneumonia (p = 0.00016) and respiratory complications (p = 0.0004), but this was not significant on multivariate analysis.

Conclusions

In this single-institution series, we found that major perioperative morbidity did not have a negative impact on long-term survival which is different than previous series. The impact of tumor characteristics at time of resection on long-term survival is of most importance.

Keywords

Esophageal Cancer Adult Respiratory Distress Syndrome Minimally Invasive Esophagectomy Veneto Region Invasive Esophagectomy 
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.

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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Brent T. Xia
    • 1
  • Ernest L. Rosato
    • 1
  • Karen A. Chojnacki
    • 1
  • Albert G. Crawford
    • 1
  • Benny Weksler
    • 1
  • Adam C. Berger
    • 1
    Email author
  1. 1.Department of SurgeryThomas Jefferson UniversityPhiladelphiaUSA

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