Long-Term Oncologic Outcomes, Opioid Use, and Complications after Esophageal Cancer Surgery

Abstract

Effective and adequate opioid use and prevention of postoperative complications are important for enhanced recovery after surgery. We examined the effects of postoperative opioid use and postoperative complications on overall survival and recurrence-free survival after esophageal cancer surgery. This retrospective cohort study analyzed the records of patients diagnosed with esophageal cancer who underwent the Ivor Lewis operation between January 2005 and December 2011. We collected data on total opioid use for 8 days postoperatively, as well as information on postoperative complications (Clavien-Dindo classification). One hundred and twenty-one patients were included in the final analysis. Total opioid use was not significantly associated with overall survival (p = 0.520) and recurrence-free survival (p = 0.818). In contrast, the hazard ratio of postoperative overall survival was significantly higher with respect to Clavien-Dindo classification 1–2 (hazard ratio: 2.009, p = 0.046), 3a–3b (hazard ratio: 5.759, p < 0.001), and 4a–5 (hazard ratio: 3.982, p = 0.020) complications compared to no complications. Additionally, the hazard ratio of the recurrence-free survival was significantly higher in class 1–2 complications (hazard ratio: 2.336, p = 0.028) compared to none. Our study demonstrates that postoperative opioid use is not associated with survival and recurrence-free survival after esophageal cancer surgery, while postoperative complications may increase the hazard ratio for survival and recurrence-free survival.

Mu Opioid Receptor 1 (MOR-1) Expression in Colorectal Cancer and Oncological Long-Term Outcomes: A Five-Year Retrospective Longitudinal Cohort Study

“…Single nucleotide polymorphism A118G have been previously linked with a reduced sensibility to exogenous opioids [27] and decreased cancer specific mortality probably due to the decreased immunosuppression associated with the G allele. Studies in breast and esophageal cancer patients found that the GG and GA alleles provided significant survival benefit compared to the AA allele [28][29][30]; it was hypothesized that a G allele increased sensitivity to endogenous opioid peptides [31,32]. In our study, we did not assess genetic polymorphism, and this could have contributed to our results, although any allele-specific in colorectal cancer patients remains to be elucidated.…”

“…In previous studies equivalent morphine consumption has contradictory impact upon disease free survival. While it decreased survival on early stages of lung cancer [38] had no impact on colorectal or esophageal cancers [30,39,40].…”

Long-Term Oncologic Outcomes for Patients Undergoing Volatile Versus Intravenous Anesthesia for Non-Small Cell Lung Cancer Surgery

“…However, we reported recently that remifentanil dosage during surgery was not clinically associated with OS or RFS in esophageal cancer surgery. 18 In summary, issues regarding the impact of epidural analgesia or opioid use on OS or RFS in lung cancer are still questionable. Therefore, the results of a prospective ongoing clinical trial (NCT01179308) will be important in the future.…”

Clinical characteristics and survival of 5283 esophageal cancer patients: A multicenter study from eighteen hospitals across six regions in China

“…There are two main pathological types of EC: esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC). ESCC is the most common histological type in developing countries, such as China [4,5]. The main treatments for EC are surgical resection, radiotherapy, and chemotherapy.…”