The Effect of Postoperative Sepsis on 1-Year Mortality and Cancer Recurrence Following Transhiatal Esophagectomy for Esophageal-Gastric Junction Adenocarcinomas: A Retrospective Observational Study

Overview

Journal Cancers (Basel)

Publisher MDPI

Date 2025 Jan 11

PMID 39796735

Authors

Marion Faucher

Samuel Dahan

Bastien Morel

Jean Manuel de Guibert

Laurent Chow-Chine

Frederic Gonzalez

Magali Bisbal

Luca Servan

Antoine Sannini

Marie Tezier

Maxime Tourret

Sylvie Cambon

Camille Pouliquen

Damien Mallet

Lam Nguyen Duong

Florence Ettori

Djamel Mokart

Affiliations

Soon will be listed here.

Abstract

Introduction: Transhiatal esophagectomy (THE) is used for specific gastroesophageal junction adenocarcinomas. THE is a high-risk surgical procedure. We aimed to assess the impact of postoperative sepsis (sepsis or septic shock) on the 1-year mortality after THE and to determine the risk factors associated with these outcomes. Secondly, we aimed to assess the impact of postoperative sepsis and other risk factors on 1-year cancer recurrence.

Method: A retrospective, observational study was undertaken at the Paoli-Calmettes Institute, Marseille, from January 2012 to March 2022.

Results: Of 118 patients, 24.6% (n = 29) presented with postoperative sepsis. Their 1-year mortality was 11% (n = 13), and their 1-year cancer recurrence was 23.7% (n = 28). In the multivariate analysis, independent factors for 1-year mortality were the following: postoperative sepsis (OR: 7.22 (1.11-47); = 0.038), number of lymph nodes removed (OR: 0. 78 (0.64-0.95); = 0.011), recurrence at one year (OR: 9.22 (1.66-51.1); = 0.011), mediastinitis (OR: 17.7 (1.43-220); = 0.025) and intraoperative driving pressure (OR: 1.77 (1.17-2.68); = 0.015). For postoperative sepsis, independent factors were low-dose vasopressors (OR: 0.26; 95% CI: 0.07-0.95; = 0.049), a cervical abscess (OR: 5.33; 95% CI: 1.5-18.9; = 0.01), bacterial pneumonia (OR: 11.1; 95% CI: 2.99-41.0; < 0.001) and a high SOFA score on day 1 (OR: 2.65; 95% CI: 1.36-5.19; = 0.04). For 1-year cancer recurrence, independent factors were the number of lymph nodes removed (sHR: 0.87; 95% CI: 0.79-0.96; = 0.005), pTNM stages of III or IV (sHR: 8.29; 95% CI: 2.71-25.32; < 0.001) and postoperative sepsis (sHR: 6.54; 95% CI: 1.70-25.13; = 0.005).

Conclusions: Our study indicates that after THE, postoperative sepsis influences survival and cancer recurrence. We identified the associated risk factors, suggesting an early diagnosis might decrease mortality and recurrence.

References

Leone M, Mokart D . Editorial: Septic shock: what we should know… or almost!. Curr Opin Anaesthesiol. 2021; 34(2):69-70. DOI: 10.1097/ACO.0000000000000964. View

Launoy G, Bossard N, Castro C, Manfredi S . Trends in net survival from esophageal cancer in six European Latin countries: results from the SUDCAN population-based study. Eur J Cancer Prev. 2016; :S24-S31. DOI: 10.1097/CEJ.0000000000000308. View

Farid S, Aldouri A, Morris-Stiff G, Khan A, Toogood G, Lodge J . Correlation between postoperative infective complications and long-term outcomes after hepatic resection for colorectal liver metastasis. Ann Surg. 2009; 251(1):91-100. DOI: 10.1097/SLA.0b013e3181bfda3c. View

Goldminc M, Maddern G, Le Prise E, Meunier B, Campion J, Launois B . Oesophagectomy by a transhiatal approach or thoracotomy: a prospective randomized trial. Br J Surg. 1993; 80(3):367-70. DOI: 10.1002/bjs.1800800335. View

Gowing S, Baker L, Tran A, Zhang Z, Ahn H, Ivanovic J . Postoperative Adverse Events are Associated with Oncologic Recurrence Following Curative-intent Resection for Lung Cancer. Lung. 2020; 198(6):973-981. DOI: 10.1007/s00408-020-00395-6. View

Schlottmann F, Strassle P, Patti M . Transhiatal vs. Transthoracic Esophagectomy: A NSQIP Analysis of Postoperative Outcomes and Risk Factors for Morbidity. J Gastrointest Surg. 2017; 21(11):1757-1763. DOI: 10.1007/s11605-017-3572-1. View

Omloo J, Lagarde S, Hulscher J, Reitsma J, Fockens P, van Dekken H . Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg. 2007; 246(6):992-1000. DOI: 10.1097/SLA.0b013e31815c4037. View

Murthy B, Thomson C, Dodwell D, Shenoy H, Mikeljevic J, Forman D . Postoperative wound complications and systemic recurrence in breast cancer. Br J Cancer. 2007; 97(9):1211-7. PMC: 2360477. DOI: 10.1038/sj.bjc.6604004. View

Ohtsuka T, Kitajima Y, Takahashi T, Sato S, Miyoshi A, Kohya N . Infectious complications after gastric cancer surgery accelerate a rapid hepatic recurrence. Hepatogastroenterology. 2009; 56(94-95):1277-80. View

10.

Korst R, Port J, Lee P, Altorki N . Intrathoracic manifestations of cervical anastomotic leaks after transthoracic esophagectomy for carcinoma. Ann Thorac Surg. 2005; 80(4):1185-90. DOI: 10.1016/j.athoracsur.2005.04.020. View

11.

Serpa Neto A, Hemmes S, S V Barbas C, Beiderlinden M, Fernandez-Bustamante A, Futier E . Association between driving pressure and development of postoperative pulmonary complications in patients undergoing mechanical ventilation for general anaesthesia: a meta-analysis of individual patient data. Lancet Respir Med. 2016; 4(4):272-80. DOI: 10.1016/S2213-2600(16)00057-6. View

12.

Rice T, Ishwaran H, Ferguson M, Blackstone E, Goldstraw P . Cancer of the Esophagus and Esophagogastric Junction: An Eighth Edition Staging Primer. J Thorac Oncol. 2016; 12(1):36-42. PMC: 5591443. DOI: 10.1016/j.jtho.2016.10.016. View

13.

Khuri S, Henderson W, DePalma R, Mosca C, Healey N, Kumbhani D . Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005; 242(3):326-41. PMC: 1357741. DOI: 10.1097/01.sla.0000179621.33268.83. View

14.

Hastbacka J, But A, Strandberg G, Lipcsey M . Risk of malignant disease in 1-year sepsis survivors, a registry-based nationwide follow-up study. Crit Care. 2023; 27(1):376. PMC: 10543324. DOI: 10.1186/s13054-023-04654-9. View

15.

Futier E, Lefrant J, Guinot P, Godet T, Lorne E, Cuvillon P . Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial. JAMA. 2017; 318(14):1346-1357. PMC: 5710560. DOI: 10.1001/jama.2017.14172. View

16.

Prowle J, Forni L, Bell M, Chew M, Edwards M, Grams M . Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative. Nat Rev Nephrol. 2021; 17(9):605-618. PMC: 8367817. DOI: 10.1038/s41581-021-00418-2. View

17.

Yende S, Kellum J, Talisa V, Peck Palmer O, Chang C, Filbin M . Long-term Host Immune Response Trajectories Among Hospitalized Patients With Sepsis. JAMA Netw Open. 2019; 2(8):e198686. PMC: 6686981. DOI: 10.1001/jamanetworkopen.2019.8686. View

18.

Hulscher J, van Sandick J, de Boer A, Wijnhoven B, Tijssen J, Fockens P . Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002; 347(21):1662-9. DOI: 10.1056/NEJMoa022343. View

19.

Mariette C, Piessen G, Balon J, Van Seuningen I, Triboulet J . Surgery alone in the curative treatment of localised oesophageal carcinoma. Eur J Surg Oncol. 2004; 30(8):869-76. DOI: 10.1016/j.ejso.2004.06.009. View

20.

Chu K, Law S, Fok M, Wong J . A prospective randomized comparison of transhiatal and transthoracic resection for lower-third esophageal carcinoma. Am J Surg. 1997; 174(3):320-4. DOI: 10.1016/s0002-9610(97)00105-0. View