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Esophageal Cancer Surgery for Patients with Concomitant Liver Cirrhosis: A Single-Center Matched-Cohort Study



Cirrhosis is a risk factor with nonhepatic surgery, but only three series regarding esophagectomy are reported. The Model for End-Stage Liver Disease (MELD) score has shown benefit in risk evaluation, but there is no experience regarding esophagectomy. This study aimed to compare the outcomes of surgery for esophageal cancer between cirrhotic and noncirrhotic patients and to evaluate whether the MELD score has a prognostic value for risk stratification.


From the authors’ esophageal cancer database, they selected all the patients with concomitant cirrhosis who underwent surgery with curative intent and a matched cohort of patients without cirrhosis. The preoperative data included demographics, medical history, blood work, American Society of Anesthesiologists (ASA) score, Child-Turcotte-Pugh (CTP) score, and MELD score. The operative data included type of surgery, radicality, operative time, and blood loss. The postoperative data included hemoderivatives, 90-day morbidity and mortality rates, lab works, and hospital length of stay. The cirrhotic patients were further divided and analyzed according to a MELD score cutoff of 9.


Of 3445 esophageal cancer patients, 73 cirrhotic patients underwent surgery. Their 90-day morbidity and mortality rates were higher than those for 146 noncirrhotic patients. The cirrhotic patients also had more respiratory events (p = 0.013) and infections (p = 0.005). The anastomotic complications among the cirrhotic patients were significantly more severe (p = 0.046). No difference in 5-year survival rates was registered. Stratification according to the MELD score showed that patients with a MELD score higher than 9 had a significantly worse postoperative course (5-year survival: p = 0.004). The patients with a MELD score of 9 or lower showed an outcome similar to that of the noncirrhotic patients.


Liver cirrhosis is not an absolute contraindication to esophagectomy. The MELD score can be applicable for esophagectomy risk assessment for cirrhotic patients.

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  1. 1.

    Zhang Y. Epidemiology of esophageal cancer. World J Gastroenterol. 2013;19:5598–606.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods, and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136:E359–86.

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Pennathur A, Gibson MK, Jobe BA, et al. Oesophageal carcinoma. Lancet. 2013;381:400–12.

    Article  PubMed  Google Scholar 

  4. 4.

    Blachier M, Leleu H, Peck-Radosavljevic M, et al. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013;58:593–608.

    Article  PubMed  Google Scholar 

  5. 5.

    Trivin F, Boucher E, Vauléon E, et al. Management of esophageal carcinoma associated with cirrhosis: a retrospective case-control analysis. J Oncol. 2009;2009:173421–5.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Dagnini G, Caldironi MW, Marin G, et al. Laparoscopy in abdominal staging of esophageal-carcinoma: report of 369 cases. Gastrointest Endosc. 1986;32:400–2.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Kalaitzakis E, Gunnarsdottir SA, Josefsson A, et al. Increased risk for malignant neoplasms among patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9:168–74.

    Article  PubMed  Google Scholar 

  8. 8.

    Simmelink AL, Dong R, Nayi V, et al. Perioperative risk assessment and management of cirrhotic patients. J Hepatol Gastroint. 2015;1:1.

    Google Scholar 

  9. 9.

    Bhangui P, Laurent A, Amathieu R, et al. Assessment of risk for nonhepatic surgery in cirrhotic patients. J Hepatol. 2012;57:874–84.

    Article  PubMed  Google Scholar 

  10. 10.

    Sabbagh C, Fuks D, Regimbeau JM. Nonhepatic gastrointestinal surgery in patients with cirrhosis. J Visc Surg. 2014;151:203–11.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Fekete F, Belghiti J, Cherqui D, et al. Results of esophagogastrectomy for carcinoma in cirrhotic patients: a series of 23 consecutive patients. Ann Surg. 1987;206:74–8.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Tachibana M, Kotoh T, Kinugasa S, et al. Esophageal cancer with cirrhosis of the liver: results of esophagectomy in 18 consecutive patients. Ann Surg Oncol. 2000;7:758–63.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Lu M-S, Liu Y-H, Wu Y-C, et al. Is it safe to perform esophagectomy in esophageal cancer patients combined with liver cirrhosis? Interact Cardiovasc Thorac Surg. 2005;4:423–5.

    Article  PubMed  Google Scholar 

  14. 14.

    Belghiti J, Cherqui D, Gayet B, et al. Esophagectomy for esophageal cancer in the cirrhotic. Gastroenterol Clin Biol. 1987;11(2BIS):A118–8.

  15. 15.

    Salerno F, Merli M, Cazzaniga M, et al. MELD score is better than Child–Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt. J Hepatol. 2002;36:494–500.

    Article  PubMed  Google Scholar 

  16. 16.

    Pagliaro L. MELD: the end of Child-Pugh classification? J Hepatol. 2002;36(1):141–142

    Article  PubMed  Google Scholar 

  17. 17.

    Northup PG, Wanamaker RC, Lee VD, et al. Model for end-stage liver disease (MELD) predicts nontransplant surgical mortality in patients with cirrhosis. Ann Surg. 2005;242:244.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Neeff H, Mariaskin D, Spangenberg H-C, et al. Perioperative mortality after nonhepatic general surgery in patients with liver cirrhosis: an analysis of 138 operations in the 2000s using Child and MELD scores. J Gastrointest Surg. 2011;15:1–11.

    Article  PubMed  Google Scholar 

  19. 19.

    Roayae A, Jibara G, Tabrizian P, et al. The role of hepatic resection in the treatment of hepatocellular cancer. Hepatology. 2015;62:440–51.

    Article  Google Scholar 

  20. 20.

    Greene FL, Page DL, Fleming ID, et al (eds). AJCC cancer staging manual. 6th ed. Springer, New York, 2002.

    Google Scholar 

  21. 21.

    Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy Esophagectomy Complications Consensus Group (ECCG). Ann Surg. 2015;262:286–94.

    Article  PubMed  Google Scholar 

  23. 23.

    Mariette B, Piessen G, Balon JM, et al. Surgery alone in the curative treatment of localised oesophageal carcinoma. Eur J Surg Oncol. 2004;30:869–76.

    CAS  Article  PubMed  Google Scholar 

  24. 24.

    Bailey SH, Bull DA, Harpole DH, et al. Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg. 2003;75:217–22.

    Article  PubMed  Google Scholar 

  25. 25.

    Mariette C, Piessen G, Lamblin A, et al. Impact of preoperative radiochemotherapy on postoperative course and survival in patients with locally advanced squamous cell oesophageal carcinoma. Br J Surg. 2006;93:1077–83.

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Liverani A, Solinas L, Di Cesare T, et al. Preoperative transjugular portosystemic shunt for oncological gastric surgery in a cirrhotic patient. World J Gastroenterol. 2015;21:997–1000.

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Christou L, Pappas G, Falagas ME. Bacterial infection-related morbidity and mortality in cirrhosis. Am J Gastroenterol. 2007;102:1510–7.

    Article  PubMed  Google Scholar 

  28. 28.

    Fernández J, Acevedo J. New antibiotic strategies in patients with cirrhosis and bacterial infection. Expert Rev Gastroenterol Hepatol. 2015;9:1495–500.

    Article  PubMed  Google Scholar 

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No funding has been obtained or used for this study. All the authors have read and confirmed that they met ICMJE criteria for authorship.


There are no conflicts of interest.

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Correspondence to Michele Valmasoni MD, PhD.

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Valmasoni, M., Pierobon, E.S., De Pasqual, C.A. et al. Esophageal Cancer Surgery for Patients with Concomitant Liver Cirrhosis: A Single-Center Matched-Cohort Study. Ann Surg Oncol 24, 763–769 (2017).

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  • Esophageal Cancer
  • Liver Cirrhosis
  • Esophageal Squamous Cell Carcinoma
  • Portal Hypertension
  • Cirrhotic Patient