Risk Factors for Complications After Esophageal Cancer Resection

Viklund, Pernilla; Lindblad, Mats; Lu, Ming; Ye, Weimin; Johansson, Jan; Lagergren, Jesper

doi:10.1097/01.sla.0000197698.17794.eb

Cited by 156 publications

(137 citation statements)

References 22 publications

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“…In general, the global, clinical judgement seems to localize a subset of patients at risk for developing complications in general, whereas many patients with no risk factors at all may develop anastomotic leakage [12]. The risk factors for anastomotic leakage identified by univariate and multivariate analysis in our study corroborate with those found in other studies [1][2][3][4][5][6][7][8]. Similar to these studies, the number of risk factors present in an individual patient appeared to be an important predictor of anastomotic leakage in all anastomoses.…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Karliczek

Harlaar

Zeebregts

et al. 2009

Int J Colorectal Dis

394

239

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Background The dramatic clinical consequences of anastomotic leakage in gastrointestinal surgery can be reduced by a diverting stoma or drainage of the peri-anastomotic area. Currently, the surgeons' clinical judgement is of major importance in decision making, but reliable data of the diagnostic accuracy are lacking. In this prospective clinical study, the surgeons' predictive accuracy for anastomotic leakage was evaluated. Materials and methods In 191 patients undergoing colorectal resection with anastomosis, the risk for anastomotic leakage was determined by the surgeon on the basis of a visual analogue scale (VAS). This risk assessment was compared to the actual occurrence of anastomotic leakage post-operatively. Results A total of 26 (13.6%) patients showed anastomotic leakage. The surgeons' median predicted leakage rate was 7.1% in anastomoses >15 cm from the anal verge and 9.5% ≤15 cm (sensitivity 38/62%, specificity 46/52%). Diagnostic accuracy was not influenced by the surgeons' training level (VAS score, surgeons 7.8% vs assistant surgeons 8.5%, p=0.96, sensitivity 41% vs 44%, specificity 59% vs 48%, p=0.20). Conclusion The surgeons' clinical risk assessment appeared to have a low predictive value for anastomotic leakage in gastrointestinal surgery. The low a priori risk of anastomotic leakage of 14% resulted in a low post-test odds (11%) of correct prediction of anastomotic leakage. This warrants the ongoing search for a better diagnostic test of anastomotic leakage to prevent morbidity and mortality.

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Section: Discussionsupporting

confidence: 88%

“…Clinically relevant anastomotic leakage rates range between 3% and 19% [1,[3][4][5][6][7][8][9]. Anastomotic leakage may remain localized, causing perianastomotic inflammation or abscess formation, or may progress to generalised peritonitis.…”

Section: Introductionmentioning

confidence: 99%

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Karliczek

Harlaar

Zeebregts

et al. 2009

Int J Colorectal Dis

394

239

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“…We avoided esophagectomy in patients with cervical involvement requiring a pharyngo-laryngectomy and in poor condition patients where the risk of post-surgical mortality is higher. In fact, the overall peri-operative death (6%) and the peri-operative complication (23%) rates were similar to those reported with surgery alone [5,39] and did not seem to be increased by this preoperative treatment.…”

Section: Discussionsupporting

confidence: 79%

“…Fifty-seven patients started the concurrent phase of the treatment: 49 (83%) of them received the whole radiotherapy dose. Unplanned interruptions of more than 2 days occurred in 14 patients as a result of toxicity; 8 patients discontinued radiotherapy due to esophagitis and diarrhea after a median of 40 Gy (range [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Table 2 lists the whole incidence of toxicity during chemo-radiotherapy.…”

Section: Chemo-radiotherapymentioning

confidence: 99%

Multi-center phase II trial of chemo-radiotherapy with 5-fluorouracil, leucovorin and oxaliplatin in locally advanced esophageal cancer

Chiarion-Sileni

Innocente

Cavina³

et al. 2008

Cancer Chemother Pharmacol

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Purpose The aim of this study was to evaluate the activity and safety of oxaliplatin/5-Xuorouracil-based chemo-radiotherapy in patients with not radically resectable locally advanced esophageal cancer. Methods Fifty-nine patients with adeno or squamous-cell carcinoma received oxaliplatin (60 mg/m 2 ), and leucovorin (20 mg/m 2 on days 1, 8,15,29,36,43,50,57) followed by continuous infusion Xuorouracil (200 mg/m 2 per day on days 1-22 and 29-64) with radiotherapy (1.8 Gy daily fractions to a total dose of 45 Gy, from days 29 to 64). When feasible, surgery was scheduled 6-8 weeks after chemoradiotherapy completion. The primary endpoint was 1-year progression-free survival. Results Forty (68%) patients completed treatment without modiWcations. An objective clinical response was seen in 35 patients (59%). Esophagectomy was possible in 33 patients and a complete resection (R0) was achieved in 26 (79%) with 6 pathologic complete responses (pCR) and 3 near pCR.At a median follow-up of 39.7 months for the surviving patients, the median progression-free and overall survivals were 11 months (95% CI 6.5-14) and 18.5 months (95% CI 13-29). The 1-year progression-free and overall survivals were 47.5% (95% CI 34-59.5%) and 63% (95% CI 49-74%). Major toxicities were esophagitis (20% G3 and 5% G4) and diarrhea (8.5% G3 and 8.5% G4). Hematological toxicity (7% G3 and 3% G4) was less common; severe neurotoxicity (3% G3) was infrequent. Conclusions Concurrent oxaliplatin, leucovorin, Xuorouracil and radiotherapy followed or not by esophagectomy has a tolerable toxicity and promising activity in locally advanced esophageal cancer.

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“…Various factors have been suggested to predispose patients to pulmonary morbidity, including advanced age, a history of smoking, cirrhosis, diabetes, an abnormal chest radiograph, lung disease, spirometric or nutritional parameters, blood loss, blood transfusion volume, low serum albumin, adjuvant oncologic therapy, general performance status, inadequate postoperative analgesia, and disease stage (2,3,5,(12)(13)(14). In the present study, we found FEV1.0%, serum CRP and smoking history to be effective preoperative predictors of postoperative respiratory complications.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative respiratory complications following esophageal cancer resection

et al. 2012

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Abstract. The development of surgical and postoperative management techniques has improved the treatment outcomes of esophageal cancer resection. However, respiratory morbidity is still the most frequent complication after esophagectomy. The objective of the present study was to identify risk factors for respiratory complications following resection for esophageal cancer. This study included 96 patients with esophageal cancer who had undergone esophagectomy with lymph node dissection. The patients were divided into 2 groups according to the presence (20 patients, 17 had pneumonia and 3 had acute respiratory distress syndrome) or absence (76 patients) of postoperative respiratory complications (PRC). The two groups were compared with respect to their preoperative clinical variables, such as age, body mass index, smoking history, serum albumin, serum C-reactive protein (CRP), number of lymphocytes, %VC, FEV1.0% and FEV1.0. Furthermore, multiple logistic regression analyses were used to estimate relative risk factors for respiratory complications. Results of the univariate analysis showed that smoking history (+/-, patients with PRC, 19/1 and without PRC, 53/23), serum CRP (≥1.0 mg/ dl/<1.0 mg/dl, patients with PRC, 6/14 and without PRC, 6/70) and FEV1.0% (≥60%/<60%, patients with PRC, 16/4 and without PRC, 73/3) were significantly different between the two groups. Multiple logistic regression analysis showed that FEV1.0% was the strongest predictor of PRC. FEV1.0%, serum CRP and smoking history are reliable predictors of the risk of respiratory complications following esophageal cancer resection. For patients with these factors, perioperative management for the prevention of postoperative respiratory complications should be considered.

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Risk Factors for Complications After Esophageal Cancer Resection

Abstract: High-volume esophageal surgeons seem to lower the risk of anastomotic leakage. More large-scale studies are warranted to establish the roles of the other potentially important risk factors suggested in our study.

Cited by 156 publications

References 22 publications

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery

Multi-center phase II trial of chemo-radiotherapy with 5-fluorouracil, leucovorin and oxaliplatin in locally advanced esophageal cancer

Risk factors for postoperative respiratory complications following esophageal cancer resection

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