Comorbidities and Risk of Complications After Surgery for Esophageal Cancer: A Nationwide Cohort Study in Sweden

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2015 May 9

PMID 25952691

Citations 13

Authors

Lovisa Backemar

Pernilla Lagergren

Therese Djarv

Asif Johar

Anna Wikman

Jesper Lagergren

Affiliations

Soon will be listed here.

Abstract

Background: The selection for surgery is multifaceted for patients diagnosed with esophageal cancer. Since it is uncertain how comorbidity should influence the selection, this study addressed comorbidities in relation to risk of severe complications following esophageal cancer surgery.

Methods: This population-based cohort study was based on prospectively included patients who underwent surgical resection for an esophageal or gastro-esophageal junctional cancer in Sweden during 2001-2005. The participation rate was 90%. Associations between pre-defined comorbidities and pre-defined post-operative complications occurring within 30 days of surgery were analyzed using multivariable logistic regression. The resulting odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for age, sex, tumor stage, tumor histology, neoadjuvant therapy, type of surgery, annual hospital volume, other comorbidities, and other complications.

Results: Among 609 included patients, those with cardiac disease (n = 92) experienced an increased risk of pre-defined complications in general (adjusted OR 1.81, 95% CI 1.13-2.90), while patients with hypertension (n = 137), pulmonary disorders (n = 79), diabetes (n = 67), and obesity (n = 66) did not. Patients with a Charlson comorbidity index score ≥2 had substantially increased risks of pre-defined complications (adjusted OR 2.44, 95% CI 1.60-3.72).

Conclusion: Cardiac disease and a Charlson comorbidity index score ≥2 seem to increase the risk of severe and early post-operative complications in patients with esophageal cancer, while hypertension, pulmonary disorders, diabetes, and obesity do not. These findings should be considered in the clinical decision-making for improved selection of patients for surgery.

Citing Articles

CRISPR/Cas9-Mediated CtBP1 Gene Editing Enhances Chemosensitivity and Inhibits Metastatic Potential in Esophageal Squamous Cell Carcinoma Cells.

Akhtar J, Imran M, Wang G Int J Mol Sci. 2023; 24(18).

PMID: 37762332 PMC: 10530806. DOI: 10.3390/ijms241814030.

An Association Between Comorbidities and Postsurgical Complications in Adults Who Underwent Esophagectomy.

Townsend A, Denton A, Gohel N, Lozano J, de la Vega P, Castro G Cureus. 2023; 15(3):e36395.

PMID: 37090319 PMC: 10115656. DOI: 10.7759/cureus.36395.

Feasibility analysis of combined surgery for esophageal cancer.

Wang Z, Sun S, Li K, Huang C, Liu X, Zhang G World J Surg Oncol. 2023; 21(1):41.

PMID: 36765428 PMC: 9912580. DOI: 10.1186/s12957-023-02930-0.

Feasibility study of adjuvant chemotherapy with S-1 after curative esophagectomy following neoadjuvant chemotherapy for esophageal cancer.

Hirahara N, Matsubara T, Kaji S, Hayashi H, Kawakami K, Sasaki Y BMC Cancer. 2022; 22(1):718.

PMID: 35768866 PMC: 9245214. DOI: 10.1186/s12885-022-09827-3.

Impact of co-morbidity on reoperation or death within 90 days of surgery for oesophageal cancer.

Cheng Z, Johar A, Gottlieb-Vedi E, Nilsson M, Lagergren J, Lagergren P BJS Open. 2021; 5(1).

PMID: 33609378 PMC: 7893455. DOI: 10.1093/bjsopen/zraa035.

References

Whooley B, Law S, Murthy S, Alexandrou A, Wong J . Analysis of reduced death and complication rates after esophageal resection. Ann Surg. 2001; 233(3):338-44. PMC: 1421248. DOI: 10.1097/00000658-200103000-00006. View

Bailey S, Bull D, Harpole D, Rentz J, Neumayer L, Pappas T . Outcomes after esophagectomy: a ten-year prospective cohort. Ann Thorac Surg. 2003; 75(1):217-22; discussion 222. DOI: 10.1016/s0003-4975(02)04368-0. View

Ludvigsson J, Andersson E, Ekbom A, Feychting M, Kim J, Reuterwall C . External review and validation of the Swedish national inpatient register. BMC Public Health. 2011; 11:450. PMC: 3142234. DOI: 10.1186/1471-2458-11-450. View

Atkins B, Shah A, Hutcheson K, Mangum J, Pappas T, Harpole Jr D . Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg. 2004; 78(4):1170-6. DOI: 10.1016/j.athoracsur.2004.02.034. View

Viklund P, Lindblad M, Lu M, Ye W, Johansson J, Lagergren J . Risk factors for complications after esophageal cancer resection: a prospective population-based study in Sweden. Ann Surg. 2006; 243(2):204-11. PMC: 1448902. DOI: 10.1097/01.sla.0000197698.17794.eb. View

Quan H, Li B, Couris C, Fushimi K, Graham P, Hider P . Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011; 173(6):676-82. DOI: 10.1093/aje/kwq433. View

Ma J, Wang Y, Zhao Y, Wu Z, Liu L, Kou Y . Atrial fibrillation after surgery for esophageal carcinoma: clinical and prognostic significance. World J Gastroenterol. 2006; 12(3):449-52. PMC: 4066066. DOI: 10.3748/wjg.v12.i3.449. View

Wright C, Kucharczuk J, OBrien S, Grab J, Allen M . Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg. 2009; 137(3):587-95. DOI: 10.1016/j.jtcvs.2008.11.042. View

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

10.

Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J . Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005; 43(11):1130-9. DOI: 10.1097/01.mlr.0000182534.19832.83. View

11.

Enzinger P, Mayer R . Esophageal cancer. N Engl J Med. 2003; 349(23):2241-52. DOI: 10.1056/NEJMra035010. View

12.

Ferri L, Law S, Wong K, Kwok K, Wong J . The influence of technical complications on postoperative outcome and survival after esophagectomy. Ann Surg Oncol. 2006; 13(4):557-64. DOI: 10.1245/ASO.2006.04.040. View

13.

Wu P, Posner M . The role of surgery in the management of oesophageal cancer. Lancet Oncol. 2003; 4(8):481-8. DOI: 10.1016/s1470-2045(03)01167-7. View

14.

Sauvanet A, Mariette C, Thomas P, Lozach P, Segol P, Tiret E . Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg. 2005; 201(2):253-62. DOI: 10.1016/j.jamcollsurg.2005.02.002. View

15.

Kassis E, Kosinski A, Ross Jr P, Koppes K, Donahue J, Daniel V . Predictors of anastomotic leak after esophagectomy: an analysis of the society of thoracic surgeons general thoracic database. Ann Thorac Surg. 2013; 96(6):1919-26. DOI: 10.1016/j.athoracsur.2013.07.119. View

16.

Schieman C, Wigle D, Deschamps C, Nichols Iii F, Cassivi S, Shen K . Patterns of operative mortality following esophagectomy. Dis Esophagus. 2012; 25(7):645-51. DOI: 10.1111/j.1442-2050.2011.01304.x. View

17.

Cijs T, Verhoef C, Steyerberg E, Koppert L, Tran T, Wijnhoven B . Outcome of esophagectomy for cancer in elderly patients. Ann Thorac Surg. 2010; 90(3):900-7. DOI: 10.1016/j.athoracsur.2010.05.039. View

18.

Rouvelas I, Zeng W, Lindblad M, Viklund P, Ye W, Lagergren J . Survival after surgery for oesophageal cancer: a population-based study. Lancet Oncol. 2005; 6(11):864-70. DOI: 10.1016/S1470-2045(05)70347-8. View

19.

Blum M, Taketa T, Sudo K, Wadhwa R, Skinner H, Ajani J . Chemoradiation for esophageal cancer. Thorac Surg Clin. 2013; 23(4):551-8. DOI: 10.1016/j.thorsurg.2013.07.006. View

20.

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M . Intensive insulin therapy in critically ill patients. N Engl J Med. 2002; 345(19):1359-67. DOI: 10.1056/NEJMoa011300. View