Postoperative Complications and Survival Rate of Esophageal Cancer: Two-period Analysis

Introduction: Nowadays, treatment of esophageal cancer requires a multidisciplinary approach, in which esophagectomy remains the mainstay. The aim of this report is to assess whether multimodal treatment and minimally invasive surgery have led to a lower morbidity rate and an improvement in survival rates.

Methods: Retrospective evaluation of 318 patients diagnosed with esophageal cancer including 81 esophagectomies. The periods of 2000-2007 and 2008-2015 were compared, analyzing the prognostic factors that may have an impact in morbidity and survival rate.

Results: Major postoperative complications according to the Clavien-Dindo classification accounted for 35%, showing a decrease between the 1. and 2. period: 41% morbidity vs. 30%, 27% mortality vs. 9% (p < .001) and 13.5% fistulas vs. 7%. The implementation of thoracoscopic esophagectomy contributed to the outcome improvement, as shown by 19% morbidity and 5% mortality rates, with triangularized mechanical anastomosis showing 9% fistula and 5% stenosis. The overall 5-year survival rate was 19%, with a significant increase from 11% in the 1. period to 28% in the 2. (p < .001).

Conclusions: Multidisciplinary assessment of patients with esophageal cancer, as well as better selection and indication of treatment and the introduction of new minimally invasive techniques (thoracoscopy and triangularized mechanical anastomosis), have improved the morbidity and mortality rates of esophagectomies, resulting in increased survival rates of these patients.