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Prognostic impact of postoperative pulmonary complications following salvage esophagectomy after definitive chemoradiotherapy
Author(s) -
Hayami Masaru,
Watanabe Masayuki,
Ishizuka Naoki,
Mine Shinji,
Imamura Yu,
Okamura Akihiko,
Kurogochi Takanori,
Yamashita Kotaro
Publication year - 2018
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24941
Subject(s) - medicine , esophagectomy , surgery , anastomosis , esophageal cancer , chemoradiotherapy , proportional hazards model , retrospective cohort study , radiation therapy , cancer
Background Postoperative complications after esophagectomy for esophageal cancer have a negative effect on patients’ survival. Although postoperative complications are more frequently observed after salvage esophagectomy than after planned esophagectomy, the effects of postoperative complications on long‐term oncologic outcomes after salvage esophagectomy remain unclear. Methods This retrospective study of 70 esophageal cancer patients after definitive chemoradiotherapy (dCRT) compared long‐term outcomes between those with and without complications. The association between morbidity and overall survival (OS) was evaluated by a Cox regression analysis. To identify the risk factors for pulmonary complications, logistic regression analysis was carried out. Results Postoperative complications occurred in 42 (60.0%) patients. Pulmonary complications and anastomotic leakage occurred in 23 (32.9%) and 9 (12.9%) patients, respectively. Overall complications and anastomotic leakage did not affect long‐term outcomes. Survival was significantly worse for patients with pulmonary complications. Radiation dose (<60 Gy), response to dCRT (complete), ypStage (0‐II), residual disease (R0), and pulmonary complications (negative) were independent factors related to a favorable OS. BMI (<20 kg/m 2 ), ASA‐PS (2‐3), and radiation dose (>60 Gy) were significant factors affecting the occurrence of pulmonary complications. Conclusions Development of postoperative pulmonary complications was independently associated with poor prognosis in patients who underwent salvage esophagectomy after dCRT.