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In-Hospital Mortality After a Surgical Resection for Esophageal Cancer: Analyses of the Associated Factors and Historical Changes

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Resections for esophageal cancer are invasive, with high mortality and morbidity rates. The object of this study was to clarify the factors associated with in-hospital death while also evaluating any associated historical changes in the characteristics of such deaths.

Methods

The factors associated with mortality were examined by logistic regression analysis in 1106 patients who underwent an esophagectomy for esophageal cancer. The historical changes in the characteristics of in-hospital deaths were also evaluated.

Results

A multivariate analysis revealed that not only undergoing an esophagectomy before 1979, but also a patient’s age (odds ratio 1.070 for every increase in age by year) and an incomplete resection (odds ratio 2.265) were independent factors associated with in-hospital death. The in-hospital mortality rates were 16.1%, 5.8%, 2.5%, and 3.1%, while the 30-day mortality rates were 9.2%, 2.2%, 0.8%, and 0.3% during 1964–1979, the 1980s, the 1990s, and the 2000s, respectively. Eight patients had preoperative comorbidities among 11 patients who died in the hospital after 1997. The mortality rate was 5.5% in patients with any comorbidities, while it was 1.3% in patients without any comorbidities (P = 0.026). The most common direct cause of in-hospital death was previous pulmonary complications; however, cancer progression has recently become the most common cause.

Conclusions

To prevent in-hospital mortality after an esophagectomy, strict indications for surgery and careful perioperative management are important, especially in high-risk patients with advanced esophageal cancer.

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Acknowledgment

We thank Brian Quinn for assisting in the preparation of the manuscript. This work was supported in part by a Grant-in-Aid from the Ministry of Education, Culture, Sport, Science and Technology of Japan.

Conflict of Interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Masaru Morita MD, PhD, FACS, Tomonori Nakanoko MD, Yoshihiko Fujinaka MD, Nobuhide Kubo MD, Keiji Yoshinaga MD, PhD, Hiroshi Saeki MD, PhD, Yasunori Emi MD, PhD, Yoshihiro Kakeji MD, PhD, FACS, Ken Shirabe MD, PhD, FACS & Yoshihiko Maehara MD, PhD, FACS

  2. Department of Innovative Applied Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Natsumi Yamashita MD & Yasunori Emi MD, PhD

Authors
  1. Masaru Morita MD, PhD, FACS
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  2. Tomonori Nakanoko MD
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  3. Yoshihiko Fujinaka MD
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  4. Nobuhide Kubo MD
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  5. Natsumi Yamashita MD
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  6. Keiji Yoshinaga MD, PhD
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  7. Hiroshi Saeki MD, PhD
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  8. Yasunori Emi MD, PhD
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  9. Yoshihiro Kakeji MD, PhD, FACS
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  11. Yoshihiko Maehara MD, PhD, FACS
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Corresponding author

Correspondence to Masaru Morita MD, PhD, FACS.

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Morita, M., Nakanoko, T., Fujinaka, Y. et al. In-Hospital Mortality After a Surgical Resection for Esophageal Cancer: Analyses of the Associated Factors and Historical Changes. Ann Surg Oncol 18, 1757–1765 (2011). https://doi.org/10.1245/s10434-010-1502-5

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  • DOI: https://doi.org/10.1245/s10434-010-1502-5

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