Thoracic Surgical Services, RWJBarnabas Health, West Orange, New Jersey, USA.
Department of Surgery, RWJBarnabas Health, Saint Barnabas Medical Center, Livingston, New Jersey, USA.
J Surg Oncol. 2021 Oct;124(5):751-766. doi: 10.1002/jso.26587. Epub 2021 Jul 5.
Esophagectomy is a complex procedure associated with a high rate of postoperative complications. It is not clear whether postoperative complications effect long-term survival. Most studies report the results from single institutions.
We examined the Surveillance, Epidemiology and End Results (SEER)-Medicare database to assess whether long-term overall and cancer-specific mortality of patients undergoing esophagectomy for cancer is impacted by postoperative complications.
Nine hundred and forty patients underwent esophagectomy from 2007 to 2014, of which 50 died, resulting in a cohort of 890 patients. Majority were males (n = 764, 85.8%) with adenocarcinoma of the lower esophagus. Almost 60% of the group had no neoadjuvant therapy. Four hundred and fifty-five patients had no major complications (51.1%), while 285 (32.0%) and 150 (16.9%) patients had one, two, or more major complications, respectively. Overall survival at 90 days was 93.1%. Multivariate analysis of patients followed up for a minimum of 90 days demonstrated that the number of complications was significantly associated with decreased overall survival but no impact on cancer-specific survival.
Our population-based analysis with its inherent limitations suggests that patients undergoing esophagectomy who experience complications have worse overall survival but not cancer-specific survival if they survive at least 90 days from the date of surgery.
食管癌切除术是一种复杂的手术，术后并发症发生率较高。目前尚不清楚术后并发症是否会影响长期生存。大多数研究报告的结果来自单一机构。
我们研究了监测、流行病学和最终结果（SEER）-医疗保险数据库，以评估接受食管癌切除术治疗癌症的患者的长期总生存率和癌症特异性生存率是否受到术后并发症的影响。
2007 年至 2014 年期间，940 例患者接受了食管癌切除术，其中 50 例死亡，因此有 890 例患者进入队列。大多数患者为男性（n=764，85.8%），下段食管腺癌。近 60%的患者未接受新辅助治疗。455 例患者无重大并发症（51.1%），285 例（32.0%）和 150 例（16.9%）患者分别有 1、2 或更多重大并发症。90 天总生存率为 93.1%。对至少随访 90 天的患者进行多变量分析表明，并发症数量与总生存率降低显著相关，但对癌症特异性生存率无影响。
我们的基于人群的分析存在固有局限性，提示在至少 90 天从手术日期开始存活的情况下，经历并发症的接受食管癌切除术的患者总生存率较差，但癌症特异性生存率无差异。
