Annals of Surgical Oncology

, Volume 23, Issue 6, pp 2106–2114 | Cite as

Postoperative Infectious Complications are Associated with Adverse Oncologic Outcomes in Esophageal Cancer Patients Undergoing Preoperative Chemotherapy

  • Kotaro Yamashita
  • Tomoki Makino
  • Hiroshi Miyata
  • Yasuhiro Miyazaki
  • Tsuyoshi Takahashi
  • Yukinori Kurokawa
  • Makoto Yamasaki
  • Kiyokazu Nakajima
  • Shuji Takiguchi
  • Masaki Mori
  • Yuichiro Doki
Thoracic Oncology



For some types of cancer, postoperative complications can negatively influence survival, but the association between these complications and oncological outcomes is unclear for patients with esophageal cancer who receive preoperative treatments.


Data were retrospectively analyzed for patients who underwent curative resection following preoperative chemotherapy for esophageal squamous cell carcinoma from 2001 to 2011. Clinicopathological parameters and cancer-specific survival (CSS) were compared between patients with and without severe postoperative complications, grade III or higher, using the Clavien–Dindo classification.


Of 255 patients identified, 104 (40.8 %) postoperatively developed severe complications. The most common complication was atelectasis in 61 (23.9 %), followed by pulmonary infection in 22 (8.6 %). Three-field lymphadenectomy, longer operation time, and more blood loss were significantly associated with a higher incidence of severe complications. Multivariate analysis of CSS revealed severe complications [hazard ratio (HR) = 1.642, 95 % confidence interval (95 % CI) 1.095–2.460, p = 0.016] as a significant prognostic factor along with pT stage [HR = 2.081, 95 % CI 1.351–3.266, p < 0.001] and pN stage [HR = 3.724, 95 % CI 2.111–7.126, p < 0.001], whereas postoperative serum C-reactive protein value was not statistically significant. Among all complications, severe pulmonary infection was the only independent prognostic factor [HR = 2.504, 95 % CI 1.308–4.427, p = 0.007].


The incidence of postoperative infectious complications, in particular pulmonary infection, is associated with unfavorable prognosis in patients with esophageal cancer undergoing preoperative chemotherapy.


Esophageal Squamous Cell Carcinoma Anastomotic Leakage Preoperative Chemotherapy Esophageal Squamous Cell Carcinoma Patient Minimally 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.


Conflict of Interest

There are no conflicts of interest.

Supplementary material

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Supplementary material 1 (PPTX 74 kb)
10434_2015_5045_MOESM2_ESM.pptx (77 kb)
Supplementary material 2 (PPTX 77 kb)


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Kotaro Yamashita
    • 1
  • Tomoki Makino
    • 1
  • Hiroshi Miyata
    • 2
  • Yasuhiro Miyazaki
    • 1
  • Tsuyoshi Takahashi
    • 1
  • Yukinori Kurokawa
    • 1
  • Makoto Yamasaki
    • 1
  • Kiyokazu Nakajima
    • 1
  • Shuji Takiguchi
    • 1
  • Masaki Mori
    • 1
  • Yuichiro Doki
    • 1
  1. 1.Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineOsakaJapan
  2. 2.Department of SurgeryOsaka Medical Center for Cancer and Cardiovascular DiseaseOsakaJapan

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