The effect of surgical complications on long-term prognosis following oesophagectomy
The effect of surgical complications on long-term prognosis following oesophagectomy
Introduction: complications are frequent after oesophagectomy, and there is evidence these adversely impact long-term prognosis. However, the effect of multiple complications, and the absolute magnitude of effect on survival is unclear. This study aimed to examine these effects in a single high-volume UK unit.
Methods: patients undergoing oesophagectomy for cancer and who survived to 90 days post-oesophagectomy were analysed. Complications were graded according to the Clavien-Dindo (CD) classification and the Comprehensive Complication Index (CCI). The effect and magnitude of effect of complications on survival were assessed using multivariable cox regression and the risk-adjusted population attributable fraction.
Results: in total, 380 patients were included. Complications occurred in 251 (66.1%). Suffering ≥3 complications (HR 1.89, 95%CI 1.13-3.16, p = 0.015) or an unplanned escalation in care (HR 2.22, 95%CI 1.43-3.45, p < 0.001) significantly reduced survival whereas pulmonary complications and anastomotic leak did not. Patients with a CCI>30 had worse overall survival (HR 1.91, 95%CI 1.32-2.76, p < 0.001) and CCI>30 due to multiple minor complications gave a worse prognosis compared to CCI>30 due to major complications (HR 2.44, 95%CI 1.14-5.20, p = 0.022). An estimated 9.1% (95%CI 3.4-14.4%) of deaths at 5 years were attributable to a CCI>30.
Conclusion: long-term survival following oesophagectomy for cancer is significantly affected by complications and the cumulative effect of multiple complications. Interestingly, multiple minor complications had a worse effect on survival than major complications. The absolute magnitude of effect is substantial: minimising all types of postoperative complications could have significant benefit to overall outcomes.
Complications, Comprehensive complication index, Cumulative complication burden, Oesophageal cancer, Oesophagectomy, Survival
Broadbent, A.
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Rahman, S.
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Grace, B.
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Walker, R.
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Noble, F.
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Kelly, J.
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Byrne, J.
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Underwood, T.
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October 2023
Broadbent, A.
11444ea9-82fd-460a-8b86-06fb58c82bcd
Rahman, S.
e2b565d4-df7f-4496-8cc3-80fc63a9e4cd
Grace, B.
eb5ebff2-17c4-4e77-bc08-fb24826d558f
Walker, R.
ba0b4c3f-095d-420a-bef8-5ccbc708fc85
Noble, F.
4f14574c-28f2-4e04-bd95-f53c7649e1fa
Kelly, J.
d703ef7b-0b1f-45d7-bf22-8c2075394130
Byrne, J.
240ed6cb-40c1-4226-bff7-8c47c6ae69d7
Underwood, T.
8e81bf60-edd2-4b0e-8324-3068c95ea1c6
Broadbent, A., Rahman, S., Grace, B., Walker, R., Noble, F., Kelly, J., Byrne, J. and Underwood, T.
(2023)
The effect of surgical complications on long-term prognosis following oesophagectomy.
European Journal of Surgical Oncology, 49 (10), [106930].
(doi:10.1016/j.ejso.2023.05.005).
Abstract
Introduction: complications are frequent after oesophagectomy, and there is evidence these adversely impact long-term prognosis. However, the effect of multiple complications, and the absolute magnitude of effect on survival is unclear. This study aimed to examine these effects in a single high-volume UK unit.
Methods: patients undergoing oesophagectomy for cancer and who survived to 90 days post-oesophagectomy were analysed. Complications were graded according to the Clavien-Dindo (CD) classification and the Comprehensive Complication Index (CCI). The effect and magnitude of effect of complications on survival were assessed using multivariable cox regression and the risk-adjusted population attributable fraction.
Results: in total, 380 patients were included. Complications occurred in 251 (66.1%). Suffering ≥3 complications (HR 1.89, 95%CI 1.13-3.16, p = 0.015) or an unplanned escalation in care (HR 2.22, 95%CI 1.43-3.45, p < 0.001) significantly reduced survival whereas pulmonary complications and anastomotic leak did not. Patients with a CCI>30 had worse overall survival (HR 1.91, 95%CI 1.32-2.76, p < 0.001) and CCI>30 due to multiple minor complications gave a worse prognosis compared to CCI>30 due to major complications (HR 2.44, 95%CI 1.14-5.20, p = 0.022). An estimated 9.1% (95%CI 3.4-14.4%) of deaths at 5 years were attributable to a CCI>30.
Conclusion: long-term survival following oesophagectomy for cancer is significantly affected by complications and the cumulative effect of multiple complications. Interestingly, multiple minor complications had a worse effect on survival than major complications. The absolute magnitude of effect is substantial: minimising all types of postoperative complications could have significant benefit to overall outcomes.
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More information
Accepted/In Press date: 4 May 2023
e-pub ahead of print date: 18 May 2023
Published date: October 2023
Additional Information:
Funding Information:
With thanks to University Hospital Southampton, and the Cancer Sciences Unit, University of Southampton. No financial support declarations.
Publisher Copyright:
© 2023 The Authors
Keywords:
Complications, Comprehensive complication index, Cumulative complication burden, Oesophageal cancer, Oesophagectomy, Survival
Identifiers
Local EPrints ID: 482258
URI: http://eprints.soton.ac.uk/id/eprint/482258
ISSN: 0748-7983
PURE UUID: aadf7758-1de8-419b-9554-33e0b31d820a
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Date deposited: 22 Sep 2023 16:36
Last modified: 18 Mar 2024 02:57
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Contributors
Author:
A. Broadbent
Author:
S. Rahman
Author:
B. Grace
Author:
R. Walker
Author:
F. Noble
Author:
J. Kelly
Author:
J. Byrne
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