Système gastro-intestinal et digestif

Abstrait

Influence of Postoperative Morbidity on Longterm Cancer Survival after Esophagogastric Resection

Eltweri AM, Sharpe D, Nyasavajjala SM, Ubhi S and Bowrey DJ

Background: Previous studies have shown that postoperative adverse events after colorectal resection predict a poor prognosis with early cancer relapse. The aim of this study was to report the outcome of patients undergoing esophagogastric resection to assess the influence of in-hospital factors on long-term cancer survival. Specifically, a standardized definition of complications was applied to this cohort and mortalities within the first 90 days were excluded from the analysis in order to remove any bias this would have.

Methods: Retrospective review of 304 patients undergoing curative esophagogastric resection for carcinoma during the period May 2003 to August 2011 at our institution. Minimum follow-up of 12 months was required; patients not surviving 90 days were excluded from the multivariate analysis.

Results: The study population comprised 83 female and 221 male patients. Cell type was adenocarcinoma (n=274), squamous cell carcinoma (n=26) and small cell carcinoma (n= 4). Surgery comprised of oesophagectomy (n=168) and gastrectomy (n=136). The 30 and 90 day mortality were 22/304 (7%) and 28/304 (9%) respectively. A hundred and fifty six patients (51%) experienced an uneventful postoperative recovery with no complications, while 148 (49%) experienced complications. According to the Clavien-Dindo classification, complications occurred with the following frequency: grade I (n=13/304, 4%), grade II (n=68/304, 23%), grade IIIa (n=6/304, 2%), grade IIIb (n=47/304, 16%), grade IVa (n=10/304, 3%) and grade IVb (n=4/304, 1%). One hundred and sixty eight patient received neoadjuvant treatment as an initial treatment intent. On multivariate analysis, UICC stage was the only independent predictor of survival (P<0.001). The occurrence of postoperative complications were not significantly associated with longterm prognosis (p=0.409).

Conclusions: Patients experiencing postoperative morbidity can expect the same long-term oncologic outcome as those not suffering these early setbacks.